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General NPI Number Information
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NPI Number | 1104994342
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Entity Type | Organization
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Legal Business Name | WAAS DRUG STORE INC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 09/29/2016
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Provider Practice Location Address
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Address Line | 1551 S 14TH ST STE 1
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1930
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Country | US
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Telephone | 904-261-3171
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Fax | 904-321-0685
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Provider Business Mailing Address
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Address Line | PO BOX 518
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City | FERNANDINA BEACH
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State | FL
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Zip | 32035-0518
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | JAMES PARKER
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Credential | RPH
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Telephone | 904-261-3171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH1804
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License Number State | FL
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