Provider Demographics
NPI:1295062107
Name:WAGNER, RYAN JAMES (PHARMD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:WAGNER
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1493 UPPER VALLEY PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-4023
Mailing Address - Country:US
Mailing Address - Phone:937-323-9129
Mailing Address - Fax:
Practice Address - Street 1:1493 UPPER VALLEY PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-4023
Practice Address - Country:US
Practice Address - Phone:937-323-9129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03331719183500000X
IN26024848A183500000X
TX42572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist