| NPI | 1679507644 |
|---|---|
| Doing Business As | WAVELAND PHARMACY |
| Entity Type | Organization |
| Authorized Contact | RUDY LETELLIER Owner Phcst 228-463-1055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MS F05352) |
| Additional Taxonomies | 333600000X Pharmacy |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2015-12-14 |