# MAYO CLINIC HEALTH SYSTEM IN WAYCROSS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MAYO CLINIC HEALTH SYSTEM IN WAYCROSS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831393107
- **Authorized official:** MR. BENJAMIN RANDOLPH WHEELER (DIRECTOR OF PHARMACY)
- **Authorized official phone:** (912) 287-2506

## Contact information

- **Practice address:** 1900 TEBEAU STREET, WAYCROSS, GA 31501-5246
- **Practice address phone:** (912) 287-2640
- **Mailing address:** 1900 TEBEAU STREET, WAYCROSS, GA 31501-5246
- **Mailing address phone:** (912) 287-2640

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | PHRE005914 | GA | Yes |

## Other

- **Enumeration date:** 06/12/2007
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 108000306 | MEDCO | GA |
| 01 | — | 1155476 | NCPDP | GA |
| 01 | — | PHRE005914 | PHARMACY LICENSE | GA |