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Deactivated NPI 1932749488 Deactivated / Inactive NPI Male Practitioner

Jonathan Mark Wagner

Pharmacist • San Angelo, TX

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Jonathan Wagner has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date January 13, 2020
NPI Deactivation Date April 09, 2026
Total Practice Duration ~6 Years of Practice (2020 – 2026)

Professional Overview & Biography Verified Profile Summary

Jonathan Wagner was a registered Pharmacist practicing in San Angelo, TX. Throughout an active medical career spanning 6 years, Jonathan Wagner provided care at the practice location at 29 S CHADBOURNE ST until profile deactivation on 2026-04-09.

Practice Location & Contact Primary Location

Practice Address

29 S Chadbourne St

San Angelo, TX 769035805

Telephone 3256553146
Associated Practice Facility / Clinic
🏢 Mp Southpark Pharmacy Llc Facility NPI 1427081447

Specialty Benchmarks & Practice Insights

Comparative analytics for Pharmacist in San Angelo, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 16.5 Yrs
Regional Practice Density
100 Specialists

Practicing in San Angelo, TX (18958 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Pharmacist Primary Specialty

NUCC Taxonomy Code: 183500000X

State License TX 48807

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, and selection; drug administration; drug regimen reviews; drug or drug-related research; provision of patient education and the provision of those acts or services necessary to provide medication therapy management services in all areas of patient care.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated April 09, 2026

Record deactivated on April 09, 2026

NPI Profile Active January 13, 2020

NPI status registered as active in NPPES database

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Updated Practice Location January 13, 2020

Registered at 29 S CHADBOURNE ST, SAN ANGELO, TX 769035805 (Tel: 3256553146)

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Updated Business Mailing Address January 13, 2020

Registered at 29 S CHADBOURNE ST, SAN ANGELO, TX 769035805 (Tel: 3256553146)

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Provider Name / Credentials Updated January 13, 2020

Recorded as JONATHAN WAGNER

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Medical Taxonomy / Specialty Registered (Primary Specialty) January 13, 2020

Pharmacist (License #48807 in TX)

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Initial NPI Registration & Enumeration January 13, 2020

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1932749488
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 13, 2020
Last Update: January 13, 2020
Deactivation Date: April 09, 2026

Mailing Address

29 S Chadbourne St

San Angelo, TX 769035805

Phone: 3256553146

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.