Healthcare Provider Details

I. General information

NPI: 1801327093
Provider Name (Legal Business Name): SAM WADDELL CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 MEADE BR
SITKA KY
41255-9335
US

IV. Provider business mailing address

377 MEADE BR
SITKA KY
41255-9335
US

V. Phone/Fax

Practice location:
  • Phone: 606-369-6356
  • Fax:
Mailing address:
  • Phone: 606-369-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberCP00108
License Number StateKY

VIII. Authorized Official

Name: SAMUEL WADDELL
Title or Position: PRESIDENT/DIRECTOR
Credential: RPH
Phone: 606-369-6356