Healthcare Provider Details

I. General information

NPI: 1346352200
Provider Name (Legal Business Name): WATERPROOF DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SERIO BLVD
FERRIDAY LA
71334-2013
US

IV. Provider business mailing address

PO BOX 669
FERRIDAY LA
71334-0669
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-4114
  • Fax: 318-757-4111
Mailing address:
  • Phone: 318-757-4114
  • Fax: 318-757-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY.001842-IR
License Number StateLA

VIII. Authorized Official

Name: WILLAIM COLVIN
Title or Position: OWNER
Credential:
Phone: 318-757-4114