Provider Demographics
NPI:1851751663
Name:WAMU LLC
Entity Type:Organization
Organization Name:WAMU LLC
Other - Org Name:ONE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PHARMACIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOYOYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARND
Authorized Official - Phone:386-447-8944
Mailing Address - Street 1:85 CYPRESS POINT PKWY UNIT B
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8455
Mailing Address - Country:US
Mailing Address - Phone:386-447-8944
Mailing Address - Fax:386-447-8940
Practice Address - Street 1:85 CYPRESS POINT PKWY UNIT B
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8455
Practice Address - Country:US
Practice Address - Phone:386-447-8944
Practice Address - Fax:386-447-8940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH30024333600000X, 3336C0003X
3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2159154OtherPK