Active NPI
Brian Edwin Wagner, PHARMD.
- Pharmacist
- Rome, NY
National Provider Identifier
1811177751
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 20 051145
- Practice address
- 1616 Black River Blvd N
Rome, NY 13440-3609 - Phone
- (315) 339-5290
- NPI assigned
- Nov 8, 2007
- Sex
- Male
- 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 | 20 051145 | NY | Primary |
Addresses
Primary practice location
1616 Black River Blvd N
Rome, NY 13440-3609
Mailing address
157 Ben Bar Cir
Whitesboro, NY 13492-3023
Phone (716) 725-1374
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 |
|---|---|---|---|
| 20 051145 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1194480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303776000000",
"number": "1811177751",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "157 BEN BAR CIR",
"city": "WHITESBORO",
"state": "NY",
"postal_code": "134923023",
"telephone_number": "716-725-1374"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1616 BLACK RIVER BLVD N",
"city": "ROME",
"state": "NY",
"postal_code": "134403609",
"telephone_number": "315-339-5290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "BRIAN",
"middle_name": "EDWIN",
"credential": "PHARMD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-11-08",
"last_updated": "2011-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NY",
"license": "20 051145",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rome, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.