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MAYO CLINIC HEALTH SYSTEM IN WAYCROSS
Institutional Pharmacy >> Pharmacy >> SuppliersRegistrant NPI Number: 1831393107
Organizational Registrant:Organization Name: MAYO CLINIC HEALTH SYSTEM IN WAYCROSS
Organization is not Subpart
Authorized Official: BENJAMIN RANDOLPH WHEELER DIRECTOR OF PHARMACY 912--28-72506
Organization is not Subpart
Authorized Official: BENJAMIN RANDOLPH WHEELER DIRECTOR OF PHARMACY 912--28-72506
Location and contact information for practice:
1900 TEBEAU STREET WAYCROSS, GA 31501-5246 US
Tel: 912-287-2640 Fax: --
Tel: 912-287-2640 Fax: --
Contact information for business:
1900 TEBEAU STREET WAYCROSS, GA 31501-5246 US
Tel: 912-287-2640 Fax: --
Tel: 912-287-2640 Fax: --
Registration Information:
NPI: 1831393107
Entity Type: Organization
Entity Type: Organization
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 3336I0012X | Suppliers Pharmacy Institutional Pharmacy | GA | PHRE005914 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| NCPDP | 1155476 | GA | 01 |
| MEDCO | 108000306 | GA | 01 |
| DEA REGISTRATION | BM2658372 | 01 | |
| PHARMACY LICENSE | PHRE005914 | GA | 01 |
