Provider Demographics
NPI:1922772193
Name:WACO OCD INC
Entity Type:Organization
Organization Name:WACO OCD INC
Other - Org Name:OLD CORNER DRUG WACO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-300-5590
Mailing Address - Street 1:PO BOX 155293
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76715-5293
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6612 W HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-6143
Practice Address - Country:US
Practice Address - Phone:254-300-5590
Practice Address - Fax:254-300-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy