Active NPI
Diane Wagner
- Pharmacotherapy Pharmacist
- Troy, MI
National Provider Identifier
1235540402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacotherapy Pharmacist
- License
- 5302022570
- Practice address
- 4963 John R Rd
Troy, MI 48085-3572 - Phone
- (248) 689-2157
- Fax
- (248) 740-5940
- NPI assigned
- May 9, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 5302022570 | MI | Primary |
Addresses
Primary practice location
4963 John R Rd
Troy, MI 48085-3572
Mailing address
4963 John R Rd
Troy, MI 48085-3572
Phone (248) 689-2157
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302022570 | MI | MD | Pharmacotherapy Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Woodward Detroit CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pharmacy
- Troy, MI
- NPI 1588776454
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1399593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1399593600000",
"number": "1235540402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4963 JOHN R RD",
"city": "TROY",
"state": "MI",
"postal_code": "480853572",
"telephone_number": "248-689-2157",
"fax_number": "248-740-5940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4963 JOHN R RD",
"city": "TROY",
"state": "MI",
"postal_code": "480853572",
"telephone_number": "248-689-2157",
"fax_number": "248-740-5940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DIANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-05-09",
"last_updated": "2014-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "MI",
"license": "5302022570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.