Provider Demographics
NPI:1578505350
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:PRESIDENT OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:REFFETT
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:41653-5349
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:41653-9168
Practice Address - Country:US
Practice Address - Phone:606-886-9954
Practice Address - Fax:606-889-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPO7635332B00000X, 3336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY207861OtherKY SALES AND USE
1825352OtherNCPDP/NABP
KY90360025OtherMEDICAID DME
KY54034004Medicaid
KY54034004Medicaid
1825352OtherNCPDP/NABP