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General NPI Number Information
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NPI Number | 1548378300
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Entity Type | Organization
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Legal Business Name | A&B WYATT ENTERPRISES, INC.
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/21/2014
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Provider Practice Location Address
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Address Line | 104 N HENRY ST
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City | STONEVILLE
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State | NC
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Zip | 27048
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Country | US
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Telephone | 336-573-2200
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Fax | 336-573-2201
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Provider Business Mailing Address
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Address Line | PO BOX 258
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City | STONEVILLE
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State | NC
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Zip | 27048-0258
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Country | US
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Telephone | 336-573-2200
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Fax | 336-573-2201
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Authorized Official
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Title or Position | OWNER/PHARMACIST MANAGER
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Name | MR. BRYAN J. WYATT
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Credential |
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Telephone | 336-573-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 08149
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License Number State | NC
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