Individual provider · Type 1 NPI

Simon B. Van Wagenen, RPH

Pharmacist · Starke, FL

NPI number 1790816072 Active

Practice location

470 W Madison St
Starke, FL 32091-3926

Call (904) 964-6759 Map

Fax (904) 964-5315

Mailing address

15604 SW 161st St
Brooker, FL 32622-2540

Specialties and licenses

TaxonomyCodeLicense
Pharmacist Primary 183500000XPS16532 (FL)

Pharmacist: An individual licensed by the appropriate state regulatory agency to engage in the practice of pharmacy. The practice of pharmacy includes, but is not limited to, assessment, interpretation, evaluation, and implementation, initiation, monitoring or modification of medication and or medical orders; the compounding or dispensing of medication and or medical orders; participation in drug and device procurement, storage…

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About NPI 1790816072

Simon B. Van Wagenen, RPH's National Provider Identifier is 1790816072, issued on Mar 8, 2007. The primary taxonomy on file is Pharmacist (183500000X), and the practice location is in Starke, FL. The record was last updated on Jul 9, 2007.