Organization
WAVERLY PHARMACY LLC
Active
Organization
WAVERLY PHARMACY LLC
Active
Other names
Waverly Pharmacy, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE MARIE TIDWELL RPH (PIC/MANAGING MEMBER)
(804) 368-3834
Entity
Organization
Contact information
Practice address
328 W MAIN ST, WAVERLY, VA 23890-3235
(804) 220-1489
(804) 834-7645
Mailing address
328 W MAIN ST, WAVERLY, VA 23890-3235
(804) 220-1489
(804) 834-7645
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
0201000860
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2164332
PK
—
Enumeration date
10/02/2006
Last updated
01/11/2018
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