Provider Demographics
NPI:1659475606
Name:ZOOT ENTERPRISES INC
Entity Type:Organization
Organization Name:ZOOT ENTERPRISES INC
Other - Org Name:WARDS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-291-7850
Mailing Address - Street 1:832 TURNER MCCALL BLVD SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-2927
Mailing Address - Country:US
Mailing Address - Phone:706-291-7850
Mailing Address - Fax:706-291-0575
Practice Address - Street 1:832 TURNER MCCALL BLVD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-2927
Practice Address - Country:US
Practice Address - Phone:706-291-7850
Practice Address - Fax:706-291-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0073243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00054986AMedicaid
1113492OtherNCPDP PROVIDER IDENTIFICATION NUMBER