Healthcare Provider Details

I. General information

NPI: 1194765842
Provider Name (Legal Business Name): WUIS VALUE DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

08337 M 140 UNIT 2
SOUTH HAVEN MI
49090-1990
US

IV. Provider business mailing address

08337 M 140 UNIT 2
SOUTH HAVEN MI
49090-1990
US

V. Phone/Fax

Practice location:
  • Phone: 269-637-3222
  • Fax: 269-637-4089
Mailing address:
  • Phone: 269-637-3222
  • Fax: 269-637-4089

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 Number5301004195
License Number StateMI

VIII. Authorized Official

Name: RYAN MOORE
Title or Position: OWNER
Credential:
Phone: 269-637-3222