Provider Demographics
NPI:1841211596
Name:WAYNESVILLE PHARMACY, INC.
Entity Type:Organization
Organization Name:WAYNESVILLE PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:BUCHANAN
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:828-456-5112
Mailing Address - Street 1:477 HAZELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-1946
Mailing Address - Country:US
Mailing Address - Phone:828-456-5112
Mailing Address - Fax:828-456-5160
Practice Address - Street 1:477 HAZELWOOD AVE
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-1946
Practice Address - Country:US
Practice Address - Phone:828-456-5112
Practice Address - Fax:828-456-5160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC057623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0445098Medicaid
NCBW4282303OtherDEA REGISTRATION NUMBER