Provider Demographics
NPI:1316969892
Name:WAGNER, WILLIAM SCOTT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SCOTT
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:CLIFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18413-0189
Mailing Address - Country:US
Mailing Address - Phone:570-222-7500
Mailing Address - Fax:570-222-7503
Practice Address - Street 1:1638 STATE ROUTE 106
Practice Address - Street 2:
Practice Address - City:CLIFFORD
Practice Address - State:PA
Practice Address - Zip Code:18413
Practice Address - Country:US
Practice Address - Phone:570-222-7500
Practice Address - Fax:570-222-7503
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP039257L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist