Active NPI
Richard Wagoner
- Pharmacist
- Mount Olive, NC
National Provider Identifier
1912359019
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26001
- Practice address
- 1019 N Breazeale Ave
Mount Olive, NC 28365-1105 - Phone
- (919) 658-2554
- NPI assigned
- Jul 13, 2016
- 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 | 26001 | NC | Primary |
Addresses
Primary practice location
1019 N Breazeale Ave
Mount Olive, NC 28365-1105
Mailing address
2937 Lowell Dr
Burlington, NC 27217-6071
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 |
|---|---|---|---|
| 26001 | NC | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edc Drug Stores Inc | Past | Accepting new patients | |
| Edc Drug Stores | 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.
-
- Community/Retail Pharmacy
- Jacksonville, NC
- NPI 1992804116
-
- Community/Retail Pharmacy
- Mount Olive, NC
- NPI 1982703112
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468368000000",
"number": "1912359019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2937 LOWELL DR",
"city": "BURLINGTON",
"state": "NC",
"postal_code": "272176071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1019 N BREAZEALE AVE",
"city": "MOUNT OLIVE",
"state": "NC",
"postal_code": "283651105",
"telephone_number": "919-658-2554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGONER",
"first_name": "RICHARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-07-13",
"last_updated": "2016-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "NC",
"license": "26001",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Olive, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.