Provider Demographics
NPI:1376315556
Name:WILLOUGHBY'S PHARMACY, LLC
Entity Type:Organization
Organization Name:WILLOUGHBY'S PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILLOUGHBY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-260-4249
Mailing Address - Street 1:2195 HIGHWAY 49 S
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MS
Mailing Address - Zip Code:39073-9420
Mailing Address - Country:US
Mailing Address - Phone:601-891-7007
Mailing Address - Fax:877-909-9434
Practice Address - Street 1:2195 HIGHWAY 49 S
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MS
Practice Address - Zip Code:39073-9420
Practice Address - Country:US
Practice Address - Phone:601-891-7007
Practice Address - Fax:877-909-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy