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NPI Code Detail

MEDICARE: DEBORAH ETHERIDGE WALDROP RPH

MEDICARE: DEBORAH ETHERIDGE WALDROP RPH
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
1183500000XPharmacistE6033MS

General Provider Information

NPI Number : 1861667818
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH ETHERIDGE WALDROP RPH
Provider Business Mailing Address
First Line : 1100 HWY 51 NORTH
Second Line :
City : MADISON
State : MS
Zip : 39110-9625
Country : US
Telephone Number : 601-853-1611
Fax Number : 601-853-7408
Provider Business Practice Location Address
First Line : 1100 HWY 51 NORTH
Second Line :
City : MADISON
State : MS
Zip : 39110-6600
Country : US
Telephone Number : 601-853-1611
Fax Number : 601-853-7408
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2008
Last Update Date : 10/21/2011

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