Provider Demographics
NPI:1205616380
Name:WAGALA, LUCY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:
Last Name:WAGALA
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:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-1203
Mailing Address - Country:US
Mailing Address - Phone:847-708-6893
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1203
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-1203
Practice Address - Country:US
Practice Address - Phone:847-708-6893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19760-40183500000X, 202D00000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No183500000XPharmacy Service ProvidersPharmacist
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine