Stephanie A Wallgren, PHARM.D.

Primary specialty

Pharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistTaxonomy code 1835P0018X

License

21125 Issued in NC

Practice address

4315 El Salvador Way
7TH SFG TMDC
Eglin Afb, FL 32542-1711

Phone

(850) 885-7555

NPI assigned

Jun 23, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1308787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1464912000000",
    "number": "1578859989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2836 PEAR ORCHARD BLVD",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325395612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4315 EL SALVADOR WAY",
            "address_2": "7TH SFG TMDC",
            "city": "EGLIN AFB",
            "state": "FL",
            "postal_code": "325421711",
            "telephone_number": "850-885-7555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLGREN",
        "first_name": "STEPHANIE",
        "middle_name": "A",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-23",
        "last_updated": "2016-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P0018X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": "NC",
            "license": "21125",
            "primary": true
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "21125",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Herbert Wagner, M.D.
• Derek Walker, MD
• Gary M Walker, M.D.
• Pamela A Walker, R.PH.
• Alexandria Kluttz Wallace, OTD, OTR
• Adam Wallum, DMD
• Rickey H Walters Jr., LCSW
• Haley Warra
• Lance R Washburn, DDS
• Terrell Washington, MD

• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Eglin Afb, FL
• Providers in Eglin Afb, FL by specialty
• Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2016; 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.