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
—
—
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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