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General NPI Number Information
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NPI Number | 1730615766
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Entity Type | Organization
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Legal Business Name | WALDRUG LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 3387 S JOG RD
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City | GREENACRES
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State | FL
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Zip | 33467-2010
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Country | US
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Telephone | 561-444-8399
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Fax | 561-653-1056
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Provider Business Mailing Address
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Address Line | PO BOX 4189
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-4189
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Country | US
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Telephone | 561-444-8399
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Fax | 561-429-8115
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Authorized Official
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Title or Position | OWNER
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Name | ANA OCHOA
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Credential |
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Telephone | 561-444-8399
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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 | PH31136
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License Number State | FL
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