Active NPI
Ellen Wanda Wagner, PHARM D
- Pharmacist
- Knoxville, TN
National Provider Identifier
1821300823
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 12235
- Practice address
- 5006 N Broadway St
Knoxville, TN 37918-2340 - Phone
- (865) 688-1812
- NPI assigned
- Jul 7, 2010
- 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 | 12235 | TN | Primary |
Addresses
Primary practice location
5006 N Broadway St
Knoxville, TN 37918-2340
Mailing address
5006 N Broadway St
Knoxville, TN 37918-2340
Phone (865) 688-1812
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 |
|---|---|---|---|
| 12235 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278460800000",
"number": "1821300823",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5006 N BROADWAY ST",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379182340",
"telephone_number": "865-688-1812"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5006 N BROADWAY ST",
"city": "KNOXVILLE",
"state": "TN",
"postal_code": "379182340",
"telephone_number": "865-688-1812"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ELLEN",
"middle_name": "WANDA",
"name_prefix": "Dr.",
"credential": "PHARM D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-07-07",
"last_updated": "2010-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "12235",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Knoxville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.