Healthcare Provider Details

I. General information

NPI: 1750426359
Provider Name (Legal Business Name): WARING WYCHE III RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 W BASE ST
MADISON FL
32340-1461
US

IV. Provider business mailing address

PO BOX 1004
MADISON FL
32341-5004
US

V. Phone/Fax

Practice location:
  • Phone: 850-973-2719
  • Fax: 850-973-2987
Mailing address:
  • Phone: 850-973-2796
  • Fax: 850-973-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS27220
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH016958
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: