Active NPI
Lisa Kroenung Wagoner, RPH
- Pharmacist
- Burlington, NC
National Provider Identifier
1609164060
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 09518
- Practice address
- 2017 W Webb Ave
Burlington, NC 27217-1063 - Phone
- (336) 221-8861
- NPI assigned
- Jul 19, 2011
- 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 | 09518 | NC | Primary |
Addresses
Primary practice location
2017 W Webb Ave
Burlington, NC 27217-1063
Mailing address
2017 W Webb Ave
Burlington, NC 27217-1063
Phone (336) 221-8861
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 |
|---|---|---|---|
| 09518 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1311033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1311033600000",
"number": "1609164060",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2017 W WEBB AVE",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272171063",
"telephone_number": "336-221-8861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2017 W WEBB AVE",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272171063",
"telephone_number": "336-221-8861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "LISA",
"middle_name": "KROENUNG",
"name_prefix": "Mrs.",
"credential": "RPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-07-19",
"last_updated": "2011-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "09518",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burlington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.