Provider Demographics
NPI:1083217582
Name:WALDROP, GEORGIA (PHARM D)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:WALDROP
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 W 135TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221-9400
Mailing Address - Country:US
Mailing Address - Phone:913-814-7003
Mailing Address - Fax:913-814-5929
Practice Address - Street 1:11900 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-9400
Practice Address - Country:US
Practice Address - Phone:913-814-7003
Practice Address - Fax:913-814-5929
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-1066583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy