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General NPI Number Information
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NPI Number | 1215723887
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Entity Type | Organization
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Legal Business Name | W5 PHARMACY LTC
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1110 E WALKER ST
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City | BRECKENRIDGE
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State | TX
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Zip | 76424-3824
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Country | US
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Telephone | 254-559-6979
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Fax | 254-559-6980
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Provider Business Mailing Address
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Address Line | 1110 E WALKER ST
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City | BRECKENRIDGE
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State | TX
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Zip | 76424-3824
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Country | US
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Telephone | 254-559-6979
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Fax | 254-559-6980
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Authorized Official
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Title or Position | OWNER/PIC
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Name | DR. CODY DEAN WIMBERLEY
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Credential | PHARMD
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Telephone | 254-366-8291
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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 | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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