Provider Demographics
NPI:1750426359
Name:WYCHE, WARING III (RPH)
Entity type:Individual
Prefix:
First Name:WARING
Middle Name:
Last Name:WYCHE
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32341-5004
Mailing Address - Country:US
Mailing Address - Phone:850-973-2796
Mailing Address - Fax:850-973-2987
Practice Address - Street 1:729 W BASE ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:FL
Practice Address - Zip Code:32340-1461
Practice Address - Country:US
Practice Address - Phone:850-973-2719
Practice Address - Fax:850-973-2987
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27220183500000X
GARPH016958183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS27220OtherPHARMCIST LISCENSE
GARPH016958OtherPHARMACIST LISCENSE