Active NPI
Jeremy Wagner, PHARMD
- Pharmacist
- Gillette, WY
National Provider Identifier
1457606378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 3549
- Practice address
- 2000 S Douglas Hwy
Gillette, WY 82718-5414 - Phone
- (307) 682-4517
- NPI assigned
- Jul 17, 2012
- Last updated
- Jul 17, 2012
- Sex
- Male
- 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 | 183500000X | 3549 | WY | Primary |
Addresses
Primary practice location
2000 S Douglas Hwy
Gillette, WY 82718-5414
Mailing address
PO Box 667
Moorcroft, WY 82721-0667
Phone (307) 756-2750
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3549 | WY | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1342483200000",
"number": "1457606378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 667",
"city": "MOORCROFT",
"state": "WY",
"postal_code": "827210667",
"telephone_number": "307-756-2750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 S DOUGLAS HWY",
"city": "GILLETTE",
"state": "WY",
"postal_code": "827185414",
"telephone_number": "307-682-4517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JEREMY",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-17",
"last_updated": "2012-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WY",
"license": "3549",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gillette, WY
- Volunteers of America Northern Rockies
- Volunteers of America Northern Rockies
- Volunteers of America Northern Rockies
- W.Michael Crosby M.D. PC
- Darylene L Wadsack, BSW
- Joan M Wagner, PCSW, CAP, CAC, LMSW
- Wal-Mart Stores, Inc. (Vision Center 30-1485)
- Walgreen Co (Walgreens #07928)
- Walgreen Co. (Coalition Family Pharmacy)
- Susan P Walla, APRN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.