Provider Demographics
NPI:1659583011
Name:WAGER, CARMEN TERESA (RPH)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:TERESA
Last Name:WAGER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 ZINNIA DR
Mailing Address - Street 2:PO BOX 368
Mailing Address - City:GLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07418-1634
Mailing Address - Country:US
Mailing Address - Phone:973-764-1628
Mailing Address - Fax:
Practice Address - Street 1:76 PIKE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1827
Practice Address - Country:US
Practice Address - Phone:845-856-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02879500183500000X
NY039730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist