Provider Demographics
NPI:1245826908
Name:WAGGONER, TONY LEE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:LEE
Last Name:WAGGONER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 RAGGED EDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-9706
Mailing Address - Country:US
Mailing Address - Phone:717-331-3953
Mailing Address - Fax:
Practice Address - Street 1:219 N BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:17065-1204
Practice Address - Country:US
Practice Address - Phone:800-266-9954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist