Provider Demographics
NPI:1417554403
Name:WAGNER, ARIELA ANISE (PHARMD)
Entity type:Individual
Prefix:
First Name:ARIELA
Middle Name:ANISE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5660 GALVESTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-8928
Mailing Address - Country:US
Mailing Address - Phone:419-250-2897
Mailing Address - Fax:
Practice Address - Street 1:720 E BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3989
Practice Address - Country:US
Practice Address - Phone:614-753-4022
Practice Address - Fax:614-753-4079
Is Sole Proprietor?:No
Enumeration Date:2020-10-03
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03439705183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist