Active NPI
Elizabeth Wagoner, DPH
- Pharmacist
- Edmond, OK
National Provider Identifier
1740794007
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 10611
- Practice address
- 1301 N Santa Fe Ave
Edmond, OK 73003-3673 - Phone
- (405) 340-0522
- NPI assigned
- Nov 24, 2017
- 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 | 10611 | OK | Primary |
Addresses
Primary practice location
1301 N Santa Fe Ave
Edmond, OK 73003-3673
Mailing address
4200 Shiloh LN
Edmond, OK 73034-6904
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10611 | OK | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oklahoma CVS Pharmacy LLC | Past | Accepting new patients | |
| Oklahoma CVS Pharmacy LLC | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1511481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511481600000",
"number": "1740794007",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 SHILOH LN",
"city": "EDMOND",
"state": "OK",
"postal_code": "730346904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 N SANTA FE AVE",
"city": "EDMOND",
"state": "OK",
"postal_code": "730033673",
"telephone_number": "405-340-0522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "ELIZABETH",
"name_prefix": "Mrs.",
"credential": "DPH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-11-24",
"last_updated": "2017-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "OK",
"license": "10611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
- Jordyn Nicole Wadley
- Emmanuel Wadmia
- Benjamin Wagner
- Cynthia Ann Wagner, R.M.T.
- Derrick Durell Wagoner, D.O.
- Wal-Mart Stores East , LP (Walmart Vision Center 30-2803)
- Wal-Mart Stores East , LP (Walmart Pharmacy 10-0389)
- Wal-Mart Stores East , LP (Walmart Vision Center 30-0389)
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2803)
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-3275)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.