Provider Demographics
NPI:1679644694
Name:WEE CARE PHARMACY INC
Entity Type:Organization
Organization Name:WEE CARE PHARMACY INC
Other - Org Name:DAVIS DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DERBIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-525-5277
Mailing Address - Street 1:1580 W ANTELOPE DR
Mailing Address - Street 2:STE 130A
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1160
Mailing Address - Country:US
Mailing Address - Phone:801-525-5277
Mailing Address - Fax:801-525-5279
Practice Address - Street 1:1580 W ANTELOPE DR
Practice Address - Street 2:STE 130A
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1160
Practice Address - Country:US
Practice Address - Phone:801-525-5277
Practice Address - Fax:801-525-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
UT653334917033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100750OtherPK
2100750OtherPK
UT=========007Medicaid