Gregory Mark Wagner, RPH

Primary specialty

PharmacistTaxonomy code 183500000X

License

114271 Issued in MN

Practice address

1020 Diffley Rd
Eagan, MN 55123-1777

Phone

(651) 452-5500

NPI assigned

Dec 8, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Pharmacist

State licenses

Practice roles

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.

• Supervalu Pharmacies Inc

  dba Cub Pharmacy

  • Community/Retail Pharmacy
  • Eagan, MN
  • NPI 1598912560
  NPD (past)
• Supervalu Pharmacies Inc.

  dba Cub Pharmacy

  • Community/Retail Pharmacy
  • Burnsville, MN
  • NPI 1093517914
  NPD (past)

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

{
    "created_epoch": "1607385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607385600000",
    "number": "1962008631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 DIFFLEY RD",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231777",
            "telephone_number": "651-452-5500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 DIFFLEY RD",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551231777",
            "telephone_number": "651-452-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "GREGORY",
        "middle_name": "MARK",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-08",
        "last_updated": "2020-12-08",
        "certification_date": "2020-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MN",
            "license": "114271",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gregory.wagner@cub.com",
            "affiliation": "N",
            "endpointDescription": "work email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "contentOtherDescription": "Cub Pharmacy",
            "address_1": "1020 Diffley Rd",
            "city": "Eagan",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551231777",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gregory.wagner@cub.com",
            "affiliation": "N",
            "endpointDescription": "employment email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1020 Diffley Rd",
            "city": "Eagan",
            "state": "MN",
            "country_code": "US",
            "postal_code": "551231777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Lee Vraa, P.T.
• Sue Ann Vruno, APRN, BC
• Linh Vu, NP
• Thao Vu
• Erica Bohlke Wagner, P.A.
• Wal-Mart Stores, Inc. (Vision Center 30-1786)
• Walgreen Co (Walgreens #05081)
• Walgreen Co (Walgreens #10641)
• Walgreen Co (Walgreens #02766)
• Joshua Wallert, DC

• Pharmacist in Eagan, MN
• Providers in Eagan, MN by specialty
• Pharmacist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2020; 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.