Angela Ree Wackowski, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

13012 Issued in TN

Practice address

130 W Ravine Rd Ste 101
Kingsport, TN 37660-3837

Phone

(423) 224-6860

Fax

(423) 224-5657

NPI assigned

Jul 5, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Locations

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.

• Walgreen Co

  • Pharmacy
  • Kingsport, TN
  • NPI 1245542737
  NPD
• Walgreen Co

  • Pharmacy
  • Kingsport, TN
  • NPI 1588679500
  NPD (past)
• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1891007068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD STE 101",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603837",
            "telephone_number": "423-224-6860",
            "fax_number": "423-224-5657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD STE 101",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603837",
            "telephone_number": "423-224-6860",
            "fax_number": "423-224-5657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WACKOWSKI",
        "first_name": "ANGELA",
        "middle_name": "REE",
        "name_prefix": "Dr.",
        "credential": "PHARMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-05",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "16086",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "13012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jayson Vittori
• Rachael Voelker, LMFT
• Wendy Hyche Vogel, NP
• Bryan Justice Vrailas
• Duc Q Vu, M.D.
• Beverly Jane Waddell, ANP, GCNS
• Benjamin Kent Wagner, LPC-MHSP
• Laura Wagner
• Megan Elizabeth Wagner, FNP-C
• Wal-Mart Stores East LP

• Pharmacist in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Pharmacist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.