Active NPI
Joan Ellen Waggoner, BSPHARM
- Pharmacist
- Shawnee, KS
National Provider Identifier
1811272305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 1-10446
- Practice address
- 5455 Roberts St
Shawnee, KS 66226-3937 - Phone
- (913) 667-1728
- Fax
- (913) 667-3368
- NPI assigned
- Oct 15, 2011
- Sex
- Female
- 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 | 1-10446 | KS | Primary |
Addresses
Primary practice location
5455 Roberts St
Shawnee, KS 66226-3937
Mailing address
510 Coronado Rd
Bonner Springs, KS 66012
Phone (913) 441-6935
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 |
|---|---|---|---|
| 1-10446 | KS | 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 and National Provider Directory roles.
-
- Pharmacy
- Shawnee, KS
- NPI 1437307329
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318636800000",
"number": "1811272305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 CORONADO RD",
"city": "BONNER SPRINGS",
"state": "KS",
"postal_code": "66012",
"telephone_number": "913-441-6935"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5455 ROBERTS ST",
"city": "SHAWNEE",
"state": "KS",
"postal_code": "662263937",
"telephone_number": "913-667-1728",
"fax_number": "913-667-3368"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "JOAN",
"middle_name": "ELLEN",
"credential": "BSPHARM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-15",
"last_updated": "2011-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KS",
"license": "1-10446",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shawnee, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 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.