| Doctor Name: | DR. EVE VAN WAGONER |
| NPI Number: | 1205235967 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHARMD |
| License Number: | 6092375-1701 |
| Business Practice Address: | 5126 W Daybreak Pkwy South Jordan, UT - 840955994 |
| Business Phone Number: | 8012134565 |
| Business Fax Number: | |
| Mailing Address: | 5126 W Daybreak Pkwy, SOUTH JORDAN |
| State: | UT |
| Postal Code: | 840955994 |
| Phone Number: | 8012134565 |
| Fax Number: | |
| NPI Enumeration Date: | 08/19/2014 |
| NPI Last Update Date: | 08/19/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1835P0018X |
| License Number: | 6092375-1701 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Pharmacy Service Providers |
| Taxonomy Classification: | Pharmacist |
| Taxonomy Specialization: | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Taxonomy Definition: | 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. |