Provider Demographics
NPI:1720193063
Name:WAGGONER, DEBBIE LYNN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:LYNN
Last Name:WAGGONER
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 1:350 RED OAK AIRPARK
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-8512
Mailing Address - Country:US
Mailing Address - Phone:501-257-6330
Mailing Address - Fax:501-257-6329
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:SLOT 119
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-6330
Practice Address - Fax:501-257-6329
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR89101835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support