Provider Demographics
NPI:1083756019
Name:WADDELL, SAMUEL L II (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:L
Last Name:WADDELL
Suffix:II
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:377 MEADE BR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:KY
Mailing Address - Zip Code:41255-9335
Mailing Address - Country:US
Mailing Address - Phone:606-369-6356
Mailing Address - Fax:
Practice Address - Street 1:377 MEADE BR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:KY
Practice Address - Zip Code:41255-9335
Practice Address - Country:US
Practice Address - Phone:606-369-6356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY011108183500000X, 1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric