Provider Demographics
NPI:1194010611
Name:WAYCROSS FAMILY PHARMACY
Entity Type:Organization
Organization Name:WAYCROSS FAMILY PHARMACY
Other - Org Name:RIVERS AND ASSOCIATES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-548-0511
Mailing Address - Street 1:1303 TEBEAU ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-5318
Mailing Address - Country:US
Mailing Address - Phone:912-548-0511
Mailing Address - Fax:912-548-0516
Practice Address - Street 1:1303 TEBEAU ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5318
Practice Address - Country:US
Practice Address - Phone:912-548-0511
Practice Address - Fax:912-548-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH025326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty