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General NPI Number Information
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NPI Number | 1194010611
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Entity Type | Organization
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Legal Business Name | WAYCROSS FAMILY PHARMACY
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Dates
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Enumeration Date | 06/13/2011
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 1303 TEBEAU ST
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City | WAYCROSS
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State | GA
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Zip | 31501-5318
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Country | US
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Telephone | 912-548-0511
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Fax | 912-548-0516
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Provider Business Mailing Address
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Address Line | 1303 TEBEAU ST
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City | WAYCROSS
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State | GA
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Zip | 31501-5318
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Country | US
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Telephone | 912-548-0511
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Fax | 912-548-0516
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. YOLANDA L RIVERS
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Credential | PHARMD
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Telephone | 912-548-0511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH025326
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License Number State | GA
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