Provider Demographics
NPI:1780018770
Name:WAGNER, ERIN L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:L
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 1:101 N TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3211
Mailing Address - Country:US
Mailing Address - Phone:770-387-2525
Mailing Address - Fax:770-387-2531
Practice Address - Street 1:101 N TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3211
Practice Address - Country:US
Practice Address - Phone:770-387-2525
Practice Address - Fax:770-387-2531
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026956183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist