Healthcare Provider Details

I. General information

NPI: 1295062941
Provider Name (Legal Business Name): WT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20597 STATE ST
ONAWAY MI
49765-8665
US

IV. Provider business mailing address

20597 STATE ST P.O. BOX 119
ONAWAY MI
49765-8665
US

V. Phone/Fax

Practice location:
  • Phone: 989-733-4106
  • Fax: 989-733-8186
Mailing address:
  • Phone: 989-733-8229
  • Fax: 989-733-8587

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 Number5301009238
License Number StateMI

VIII. Authorized Official

Name: RYAN HOWELL
Title or Position: VP
Credential:
Phone: 989-733-8229