Provider Demographics
NPI:1003257643
Name:WCRX OF HOLLYWOOD LLC
Entity Type:Organization
Organization Name:WCRX OF HOLLYWOOD LLC
Other - Org Name:WCRX PHARMACY LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:EMMANUEL
Authorized Official - Last Name:INWANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-222-1963
Mailing Address - Street 1:175 SALEM CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-2809
Mailing Address - Country:US
Mailing Address - Phone:850-222-1963
Mailing Address - Fax:850-224-9356
Practice Address - Street 1:210 S FEDERAL HWY STE 317
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-6811
Practice Address - Country:US
Practice Address - Phone:850-222-1963
Practice Address - Fax:850-224-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-11
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1835P2201X
FLPH24084302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302R00000XManaged Care OrganizationsHealth Maintenance OrganizationGroup - Multi-Specialty
No1835P2201XPharmacy Service ProvidersPharmacistAmbulatory CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000970500Medicaid