Active NPI
Kristin Jo Wagner
- Pharmacist
- Spokane, WA
National Provider Identifier
1992879092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH00020076
- Practice address
- 3919 N Maple St
Spokane, WA 99205-1349 - Phone
- (509) 444-8888
- Fax
- (509) 444-7810
- NPI assigned
- Nov 20, 2006
- Sex
- Female
- 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 | PH00020076 | WA | Primary |
Addresses
Primary practice location
3919 N Maple St
Spokane, WA 99205-1349
Mailing address
35925 N Pike Rd
Deer Park, WA 99006-9147
Phone (509) 292-8398
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 |
|---|---|---|---|
| PH00020076 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992879092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35925 N PIKE RD",
"city": "DEER PARK",
"state": "WA",
"postal_code": "990069147",
"telephone_number": "509-292-8398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3919 N MAPLE ST",
"city": "SPOKANE",
"state": "WA",
"postal_code": "992051349",
"telephone_number": "509-444-8888",
"fax_number": "509-444-7810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "KRISTIN",
"middle_name": "JO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH00020076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spokane, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.