# WALDRIP PHARMS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medicap Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679623995
- **Authorized official:** DENA FERMAN (THIRD PARTY PLAN COORDINATOR)
- **Authorized official phone:** (314) 993-6000

## Contact information

- **Practice address:** 425 DESOTO AVE, CLARKSDALE, MS 38614-5214
- **Practice address phone:** (662) 627-0100
- **Practice address fax:** (662) 627-0102
- **Mailing address:** 425 DESOTO AVE, CLARKSDALE, MS 38614-5214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 0332901MC | MS | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 01/11/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0330233 | — | MS |
| 01 | — | 2518554 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |