John C Wagner, RPH – Pharmacist in Hampton, SC

Key facts

NPI: 1821384728
Entity type: Individual (NPI type 1)
Primary specialty: Pharmacist 183500000X
License: 11713 (SC)
Practice address: 1703 Elm St W
Hampton, SC 29924
Phone: (803) 943-0983
Fax: (803) 943-0783
NPI assigned: Jun 20, 2011
Sex: Male
Sole proprietor: Yes

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No
Credentials: Registered Pharmacist

State licenses

License	State	Type	Specialty
11713	SC	MD	Social Worker
5302023891	MI	MD	Pharmacist

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacist	183500000X	5302023891	MI
Pharmacist	183500000X	11713	SC	Yes

Addresses

Primary practice location

1703 Elm St W
Hampton, SC 29924

Mailing address

1703 Elm St W
Hampton, SC 29924
Phone (803) 943-0983

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 20, 2011.

{
    "created_epoch": "1308528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308528000000",
    "number": "1821384728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1703 ELM ST W",
            "city": "HAMPTON",
            "state": "SC",
            "postal_code": "29924",
            "telephone_number": "803-943-0983",
            "fax_number": "803-943-0783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 ELM ST W",
            "city": "HAMPTON",
            "state": "SC",
            "postal_code": "29924",
            "telephone_number": "803-943-0983",
            "fax_number": "803-943-0783"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "JOHN",
        "middle_name": "C",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-20",
        "last_updated": "2011-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MI",
            "license": "5302023891",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "SC",
            "license": "11713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, SC

All providers in Hampton, SC · Pharmacist in South Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2011. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.