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Organization
WALDRIP PHARMS LLC
Active
Organization
WALDRIP PHARMS LLC
Active
Other names
Medicap Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
(314) 993-6000
Entity
Organization
Contact information
Practice address
425 DESOTO AVE, CLARKSDALE, MS 38614-5214
(662) 627-0100
(662) 627-0102
Mailing address
425 DESOTO AVE, CLARKSDALE, MS 38614-5214
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
0332901MC
MS
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0330233
—
MS
01
—
2518554
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
01/11/2007
Last updated
03/07/2023
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