Nicole L Wagner, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

44258 Issued in TX

Practice address

6601 Watauga Rd Ste 126
Watauga, TX 76148-3331

Phone

(817) 702-6634

Fax

(817) 702-6604

NPI assigned

Nov 17, 2009

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tarrant County Hospital District

  • Community/Retail Pharmacy
  • Watauga, TX
  • NPI 1063678324
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1258416000000",
    "number": "1164759882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 WATAUGA RD STE 126",
            "city": "WATAUGA",
            "state": "TX",
            "postal_code": "761483331",
            "telephone_number": "817-702-6634",
            "fax_number": "817-702-6604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 WATAUGA RD STE 126",
            "city": "WATAUGA",
            "state": "TX",
            "postal_code": "761483331",
            "telephone_number": "817-702-6634",
            "fax_number": "817-702-6604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "NICOLE",
        "middle_name": "L",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-11-17",
        "last_updated": "2009-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "44258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manjusha Tummala, DDS
• Urgent Care Clinics of North Texas Inc
• Ashley Valamides, LMSW
• Visionworks, Inc.
• Vital Spine Therapy LLC
• Walgreen Co
• Janice Elaine Walker
• Jon Vincent Washington
• Watauga Family Dentistry PLLC
• Watauga I Enterprises, L.L.C.

• Pharmacist in Watauga, TX
• Providers in Watauga, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.