Provider Demographics
NPI:1528416898
Name:WAYNE PHARMACY, INC.
Entity Type:Organization
Organization Name:WAYNE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-735-6936
Mailing Address - Street 1:2302 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-1726
Mailing Address - Country:US
Mailing Address - Phone:919-735-6936
Mailing Address - Fax:919-735-1109
Practice Address - Street 1:2302 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-1726
Practice Address - Country:US
Practice Address - Phone:919-735-6936
Practice Address - Fax:919-735-1109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12912333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0965046Medicaid