Active NPI
Elizabeth M Wagner
- Pharmacist
- West Allis, WI
National Provider Identifier
1306434592
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10404-40
- Practice address
- 10233 W Greenfield Ave
West Allis, WI 53214-3911 - Phone
- (414) 727-5750
- NPI assigned
- Jan 4, 2021
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10404-40 | WI | Primary |
Addresses
Primary practice location
10233 W Greenfield Ave
West Allis, WI 53214-3911
Mailing address
3759 N 88TH St Apt 303
Milwaukee, WI 53222-2729
Phone (414) 315-2453
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 |
|---|---|---|---|
| 10404-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609718400000",
"number": "1306434592",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3759 N 88TH ST APT 303",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "532222729",
"telephone_number": "414-315-2453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10233 W GREENFIELD AVE",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "532143911",
"telephone_number": "414-727-5750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ELIZABETH",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-01-04",
"last_updated": "2021-01-04",
"certification_date": "2021-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "10404-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Allis, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.