Provider Demographics
NPI:1699591966
Name:WAGNER, EMILY NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NICOLE
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 1:7425 CHAVENELLE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-9674
Mailing Address - Country:US
Mailing Address - Phone:563-588-8709
Mailing Address - Fax:
Practice Address - Street 1:7425 CHAVENELLE RD STE 300
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-9674
Practice Address - Country:US
Practice Address - Phone:563-588-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22552-40183500000X
IA23377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist