Provider Demographics
NPI:1356381545
Name:WAGNER, VANCE N (PHARMD)
Entity type:Individual
Prefix:MR
First Name:VANCE
Middle Name:N
Last Name:WAGNER
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 1:2802 WHISPERING OAKS LN
Mailing Address - Street 2:
Mailing Address - City:FORT CALHOUN
Mailing Address - State:NE
Mailing Address - Zip Code:68023-5252
Mailing Address - Country:US
Mailing Address - Phone:402-657-0917
Mailing Address - Fax:
Practice Address - Street 1:14301 FIRST NATIONAL BANK PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-7201
Practice Address - Country:US
Practice Address - Phone:800-633-7928
Practice Address - Fax:800-801-2395
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist