Healthcare Provider Details

I. General information

NPI: 1952473571
Provider Name (Legal Business Name): W & D PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 COURT SQUARE
SUMNER MS
38957-0217
US

IV. Provider business mailing address

PO BOX 217
SUMNER MS
38957-0217
US

V. Phone/Fax

Practice location:
  • Phone: 662-375-8768
  • Fax: 662-375-8003
Mailing address:
  • Phone:
  • Fax:

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 Number00844/1.1
License Number StateMS

VIII. Authorized Official

Name: EDWARD WOO
Title or Position: OWNER
Credential: RPH
Phone: 662-375-8768