Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Simon B Van Wagenen, RPH

Individual provider Pharmacist · NPI 1790816072

Mr. Simon B Van Wagenen, RPH is a Pharmacist in Starke, Florida. Licensed in Florida. Registered with an NPI since 2007.

Licensed in
FL
In the registry since
2007
What do these letters mean?
RPH — Registered Pharmacist
A pharmacist licensed by a state board.

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Practice location Address checks out

470 W Madison St
Starke, FL 32091-3926
Phone: (904) 964-6759
Fax: (904) 964-5315
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pharmacist (primary) Taxonomy 183500000X · Licence PS16532 (FL)

Record details

NPI number1790816072
Entity typeIndividual (Type 1)
GenderMale
Credentials RPH
Sole proprietorNo
NPI enumeratedMarch 8, 2007
Last updated in NPPESJuly 9, 2007

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