Provider Demographics
NPI:1194765842
Name:WUIS VALUE DRUGS INC
Entity type:Organization
Organization Name:WUIS VALUE DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-637-3222
Mailing Address - Street 1:08337 M 140
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-1990
Mailing Address - Country:US
Mailing Address - Phone:269-637-3222
Mailing Address - Fax:269-637-4089
Practice Address - Street 1:08337 M 140
Practice Address - Street 2:UNIT 2
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-1990
Practice Address - Country:US
Practice Address - Phone:269-637-3222
Practice Address - Fax:269-637-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010041953336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2039217OtherPK
MI1653235Medicaid
MI1653235Medicaid