Provider Demographics
NPI:1710268768
Name:WAGNER, HEATHER H (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:H
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-1306
Mailing Address - Country:US
Mailing Address - Phone:302-832-2300
Mailing Address - Fax:302-832-2305
Practice Address - Street 1:1120 PULASKI HWY
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1306
Practice Address - Country:US
Practice Address - Phone:302-832-2300
Practice Address - Fax:302-832-2305
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003838183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist