Active NPI
Seth Allen Wagner, PHARMD
- Pharmacist
- Saint Peters, MO
National Provider Identifier
1912580465
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 2016007951
- Practice address
- 1749 Woodstone Dr
Saint Peters, MO 63376-7404 - Phone
- (636) 447-1229
- NPI assigned
- May 3, 2021
- Last updated
- Sep 6, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 051297649 | IL | |
| Pharmacist | 183500000X | 2016007951 | MO | Primary |
Addresses
Primary practice location
1749 Woodstone Dr
Saint Peters, MO 63376-7404
Mailing address
2300 Highway K
O Fallon, MO 63368-6661
Phone (636) 379-1918
Other practice location 1
2300 Highway K
O Fallon, MO 63368-6661
Phone (636) 379-1918
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 |
|---|---|---|---|
| 051297649 | IL | MD | Pharmacist |
| 2016007951 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Missouri CVS Pharmacy LLC | Past | Accepting new patients | |
| Missouri CVS Pharmacy LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693958400000",
"number": "1912580465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 HIGHWAY K",
"city": "O FALLON",
"state": "MO",
"postal_code": "633686661",
"telephone_number": "636-379-1918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1749 WOODSTONE DR",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633767404",
"telephone_number": "636-447-1229"
}
],
"practiceLocations": [
{
"address_1": "2300 Highway K",
"address_purpose": "LOCATION",
"city": "O Fallon",
"state": "MO",
"postal_code": "633686661",
"country_code": "US",
"telephone_number": "636-379-1918",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WAGNER",
"first_name": "SETH",
"middle_name": "ALLEN",
"credential": "PHARMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-05-03",
"last_updated": "2023-09-06",
"certification_date": "2023-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": "051297649",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MO",
"license": "2016007951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Peters, MO
- Voyager Group, Inc (Physicians Pain Clinic)
- Stephanie Renee' Vunck, M.A CF-SLP
- Vvasudevan LLC
- Hannah Elizabeth Wade, BCBA, LBA
- Erica Wagner, DPT
- Hunter Wagoner, PLPC
- Sydney Wahl, DMD
- Wal-Mart Stores East LP (Walmart Pharmacy 10-5421)
- Wal-Mart Stores East LP (Walmart Pharmacy 10-0648)
- Wal-Mart Stores East, LP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.