Provider Demographics
NPI:1306043757
Name:LITTLE & WADDELL, INC
Entity Type:Organization
Organization Name:LITTLE & WADDELL, INC
Other - Org Name:MEDZONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-889-9003
Mailing Address - Street 1:PO BOX 1349
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-1349
Mailing Address - Country:US
Mailing Address - Phone:606-889-9003
Mailing Address - Fax:606-889-9404
Practice Address - Street 1:5291 KENTUCKY ROUTE 321
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-1349
Practice Address - Country:US
Practice Address - Phone:606-889-9003
Practice Address - Fax:606-889-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYP06426332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies