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Organization
MAYO CLINIC HEALTH SYSTEM IN WAYCROSS
Active
Organization
MAYO CLINIC HEALTH SYSTEM IN WAYCROSS
Active
Other names
MAYO CLINIC HEALTH SYSTEM IN WAYCROSS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN RANDOLPH WHEELER (DIRECTOR OF PHARMACY)
(912) 287-2506
Entity
Organization
Contact information
Practice address
1900 TEBEAU STREET, WAYCROSS, GA 31501-5246
(912) 287-2640
Mailing address
1900 TEBEAU STREET, WAYCROSS, GA 31501-5246
(912) 287-2640
Taxonomy
Speciality
Code
Description
License number
State
3336I0012X
Institutional Pharmacy
Primary
PHRE005914
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108000306
MEDCO
GA
01
—
1155476
NCPDP
GA
01
—
PHRE005914
PHARMACY LICENSE
GA
Enumeration date
06/12/2007
Last updated
03/07/2023
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