Charles Alllen Wagner

Primary specialty

Pharmacy TechnicianTaxonomy code 183700000X

License

67010074A Issued in IN

Practice address

1804 Connecticut Ave
Elkhart, IN 46514-8367

Phone

(574) 218-2613

NPI assigned

Aug 18, 2022

Last updated

Aug 22, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kroger Limited Partnership I

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Elkhart, IN
  • NPI 1861565483
  NPD (past)
• Kroger Limited Partnership I

  dba Kroger Pharmacy #473

  • Community/Retail Pharmacy
  • Newport, KY
  • NPI 1104791078
  NPD (past)

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

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1356069082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 JOHNSON ST",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465143329",
            "telephone_number": "574-264-5996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1804 CONNECTICUT AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465148367",
            "telephone_number": "574-218-2613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CHARLES",
        "middle_name": "ALLLEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-18",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183700000X",
            "taxonomy_group": "",
            "desc": "Pharmacy Technician",
            "state": "IN",
            "license": "67010074A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jona Vitela, MSW, LCSW, LCAC
• Rachel J Voth Schrag
• Jennifer Suzanne Wade, O.D.
• Kelly L Wade, B.A.
• Deanna D. Waggy, O.T.
• Yvonne Wainaina
• Gabriella Wakes
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2679)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-4399)
• Wal-Mart Stores East, LP (Vision Center 30-2679)

• Pharmacy Technician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Pharmacy Technician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.