Organization
WAUKA MOUNTAIN PHARMACY INC
Active
Other names
WAUKA MOUNTAIN PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
SHWETA WOODSMALL PHARMD (OWNER / PHARMACIST)
(770) 983-9556
Entity
Organization
Contact information
Practice address
5233 CLEVELAND HWY, CLERMONT, GA 30527-2205
(770) 983-9556
(770) 983-9580
Mailing address
PO BOX 410, CLERMONT, GA 30527-0410
(770) 983-9556
(770) 983-9580
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE006914
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00362865A
—
GA
01
—
2015525
PK
—
Enumeration date
01/25/2007
Last updated
06/18/2019
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