Provider Demographics
NPI:1912023722
Name:WAGONER, DAWN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:WAGONER
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 1:315 PENWYLLT CT
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1428
Mailing Address - Country:US
Mailing Address - Phone:610-280-3920
Mailing Address - Fax:
Practice Address - Street 1:225 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:FRAZER
Practice Address - State:PA
Practice Address - Zip Code:19355-1875
Practice Address - Country:US
Practice Address - Phone:610-640-9641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP044454L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist