MEDICARE: WAYNE PHARMACY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy	12912	NC
2	3336C0003X	Community/Retail Pharmacy	12912	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528416898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAYNE PHARMACY, INC.

Provider Business Mailing Address
First Line	:	2302 WAYNE MEMORIAL DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1726
Country	:	US
Telephone Number	:	919-735-6936
Fax Number	:	919-735-1109

Provider Business Practice Location Address
First Line	:	2302 WAYNE MEMORIAL DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27534-1726
Country	:	US
Telephone Number	:	919-735-6936
Fax Number	:	919-735-1109

Authorized Official
Title or Position	:	CORPORATION PRESIDENT
Name	:	KENNETH L WIGGINS JR.
Credential	:
Telephone Number	:	919-735-6936

Provider Enumeration Date	:	05/27/2016
Last Update Date	:	05/27/2016

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Directions to “WAYNE PHARMACY, INC. ” Practice Location

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