Provider Demographics
NPI:1083749097
Name:WAYNE MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:WAYNE MEMORIAL HOSPITAL
Other - Org Name:WEB PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:SR VICE PRESIDENT FINANCE / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:THOMA
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:919-731-6143
Mailing Address - Street 1:2700 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9494
Mailing Address - Country:US
Mailing Address - Phone:919-731-6801
Mailing Address - Fax:919-731-6097
Practice Address - Street 1:2700 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9494
Practice Address - Country:US
Practice Address - Phone:919-731-6801
Practice Address - Fax:919-731-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3402877OtherNCPDP