Provider Demographics
NPI:1801327093
Name:SAM WADDELL CONSULTING INC
Entity type:Organization
Organization Name:SAM WADDELL CONSULTING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:606-369-6356
Mailing Address - Street 1:377 MEADE BR
Mailing Address - Street 2:
Mailing Address - City:SITKA
Mailing Address - State:KY
Mailing Address - Zip Code:41255-9335
Mailing Address - Country:US
Mailing Address - Phone:606-369-6356
Mailing Address - Fax:
Practice Address - Street 1:377 MEADE BR
Practice Address - Street 2:
Practice Address - City:SITKA
Practice Address - State:KY
Practice Address - Zip Code:41255-9335
Practice Address - Country:US
Practice Address - Phone:606-369-6356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCP00108333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy