Provider Demographics
NPI:1780387019
Name:WB DRUG COMPANY INC
Entity type:Organization
Organization Name:WB DRUG COMPANY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WIETER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:618-532-2200
Mailing Address - Street 1:1071 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-5309
Mailing Address - Country:US
Mailing Address - Phone:618-532-2200
Mailing Address - Fax:618-533-0566
Practice Address - Street 1:1071 W BROADWAY
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-5309
Practice Address - Country:US
Practice Address - Phone:618-532-2200
Practice Address - Fax:618-533-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies