MS. MEREDITH WAGNER (NPI# 1982817961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982817961 |
| Entity Type | Individual |
| Full Name | MS. MEREDITH WAGNER |
| Credential | PHARM D. |
| Practice Address |
3408 Pemberton Square Blvd Vicksburg MS 39180-5573 |
| Mailing Address |
415 Pemberton Dr Pearl MS 39208-5319 |
| Practice Telephone | 6016304003 |
| Practice Fax Number | 6016304004 |
| Mailing Telephone | 6014209711 |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-03-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
E09950 | MS | Pharmacy Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316380694 | Meredith Wall Wagner | Surgery | 6254 Poplar Ave, Memphis, TN 38119 | 2013-04-16 |
| 1134381361 | Meredith A Wagner | Anesthesiology | 622 W 168th St, Ph5-505c, New York, NY 10032-3720 | 2008-06-29 |
| 1417143959 | Meredith G Wagner | Dietitian, Registered | 700 1st Ave S, Fargo, ND 58103-1802 | 2007-09-19 |
| Street Address |
3408 PEMBERTON SQUARE BLVD |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-5573 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407494198 | Josiefina Golden Burgess | Pharmacist | 3408 Pemberton Square Blvd, Vicksburg, MS 39180-5573 | 2019-12-13 |
| 1346888054 | Brittany Fowler | Pharmacist | 3408 Pemberton Square Blvd, Vicksburg, MS 39180-5573 | 2019-12-12 |
| 1093353807 | Sarah Grace Pittman | Pharmacist | 3408 Pemberton Square Blvd, Vicksburg, MS 39180-5573 | 2019-12-12 |
| 1164670063 | Kroger Limited Partnership I | Durable Medical Equipment & Medical Supplies | 3408 Pemberton Square Blvd, Vicksburg, MS 39180-5573 | 2008-09-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255877346 | Elite Performance and Rehab, LLC | Clinic/Center | 1901 A Mission 66, Vicksburg, MS 39180 | 2017-01-12 |
| 1679931083 | Heather M Anderson | Physician Assistant | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180 | 2016-02-01 |
| 1245604941 | Warren County Assn.for Retarded Citizens, Inc. | Day Training, Developmentally Disabled Services | 100 Smokey Lane, Vicksburg, MS 39180 | 2015-11-18 |
| 1386012904 | Brian Oliver Snowden | Counselor | 3530 Manor Dr Ste 5a, Vicksburg, MS 39180 | 2015-09-14 |
| 1962802710 | Jordan P. Crocker, D.m.d., Pllc | Clinic/Center | 109 Monument Place, Vicksburg, MS 39180 | 2014-08-29 |
| 1821434259 | Trisha Addison | Physical Therapist | 2222 South Frontage Road, Suite D, Vicksburg, MS 39180 | 2013-05-13 |
| 1073862157 | Laura Jeanne Briggs | Physical Therapist | 1901-a Mission 66, Vicksburg, MS 39180 | 2012-09-05 |
| 1912175258 | Andrea T. Harris | Counselor | Warren-yazoo Mental Health Service, 3444 Wisconsin Ave., Vicksburg, MS 39180 | 2008-02-20 |
| 1922217314 | Austin Family Dentistry | Dentist | 3040 Indiana Ave, Vicksburg, MS 39180 | 2007-05-22 |
| 1063539138 | Ollie Hardaway Jr. | Dentist | 154 Cottonwood Street, Vicksburg, MS 39180 | 2007-03-23 |
| Find all providers in zip 39180 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467085274 | Kenneth Martin | Pharmacist | 1811 West Govt St, Brandon, MS 39042-2106 | 2020-02-20 |
| 1316585581 | Deborah Magoun Rosenbaum | Pharmacist | [email protected], 4910 I-55 North, Jackson, MS 39211 | 2019-12-18 |
| 1326686932 | Joshua Brett Manning | Pharmacist | Kroger, 2340 Highway 15 N, Laurel, MS 39440-1831 | 2019-12-13 |
| 1023585296 | Brenda M Wise | Pharmacist | 301 Fisher St # 2b, Biloxi, MS 39534-2508 | 2018-10-25 |
| 1508311028 | Koshy Mathew | Pharmacist | 122 Mcdill Cv, Madison, MS 39110-6562 | 2016-08-25 |
| 1992106413 | Roland Mullins Jr. | Pharmacist | 301 Fisher St Rm 309b, Keesler Afb, MS 39534-2508 | 2014-09-16 |
| 1124432679 | Tara Lynn Felder | Pharmacist | 1121 Hwy 98/51, Summit, MS 39666 | 2014-06-12 |
| 1912333956 | Carman G Cochran | Pharmacist | 68 Buffalo Rd, Mc Lain, MS 39456-2330 | 2013-09-23 |
| 1902239197 | Melanie Hammill Bishop | Pharmacist | 427 Ms Highway 51 North, Brookhaven, MS 39601 | 2013-08-12 |
| 1578833299 | April Malone | Pharmacist | 208 S 27th Ave, Hattiesburg, MS 39401-7173 | 2012-01-11 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.