Provider Demographics
NPI:1033831433
Name:WAGNON, MEGAN M (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:M
Last Name:WAGNON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5523 LAWRENCE LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-3762
Mailing Address - Country:US
Mailing Address - Phone:307-760-9680
Mailing Address - Fax:
Practice Address - Street 1:1708 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4945
Practice Address - Country:US
Practice Address - Phone:307-829-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist