Healthcare Provider Details

I. General information

NPI: 1649908252
Provider Name (Legal Business Name): WPH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MCFARLAND RD
LOOKOUT MTN GA
30750-3194
US

IV. Provider business mailing address

100 MCFARLAND RD
LOOKOUT MTN GA
30750-3194
US

V. Phone/Fax

Practice location:
  • Phone: 423-718-8521
  • Fax:
Mailing address:
  • Phone: 423-718-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN BEARD
Title or Position: OWNER
Credential:
Phone: 423-718-8521