Active NPI
Heidi Maria Wagner, RPH
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Burton, MI
National Provider Identifier
1457518896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 5302028617
- Practice address
- 2333 S Center Rd
Burton, MI 48519-1147 - Phone
- (810) 744-9733
- NPI assigned
- May 22, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 5302028617 | MI | Primary |
Addresses
Primary practice location
2333 S Center Rd
Burton, MI 48519-1147
Mailing address
9163 Woodridge Dr
Davison, MI 48423-8392
Phone (810) 658-0828
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
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5302028617 | MI | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211414400000",
"number": "1457518896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9163 WOODRIDGE DR",
"city": "DAVISON",
"state": "MI",
"postal_code": "484238392",
"telephone_number": "810-658-0828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2333 S CENTER RD",
"city": "BURTON",
"state": "MI",
"postal_code": "485191147",
"telephone_number": "810-744-9733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "HEIDI",
"middle_name": "MARIA",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-22",
"last_updated": "2008-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "MI",
"license": "5302028617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burton, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.