Provider Demographics
NPI:1730123787
Name:W&B PLAZA PHARMACY INC
Entity Type:Organization
Organization Name:W&B PLAZA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-237-6621
Mailing Address - Street 1:204 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3648
Mailing Address - Country:US
Mailing Address - Phone:478-237-6621
Mailing Address - Fax:478-237-2217
Practice Address - Street 1:204 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3648
Practice Address - Country:US
Practice Address - Phone:478-237-6621
Practice Address - Fax:478-237-2217
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:W & B PLAZA PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0045493336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000037881AMedicaid