Provider Demographics
NPI:1306540935
Name:WALDRIP, HAROLD KEITH
Entity type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:KEITH
Last Name:WALDRIP
Suffix:
Gender:M
Credentials:
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 231
Mailing Address - Street 2:
Mailing Address - City:POPE
Mailing Address - State:MS
Mailing Address - Zip Code:38658-0231
Mailing Address - Country:US
Mailing Address - Phone:662-609-1443
Mailing Address - Fax:
Practice Address - Street 1:110 KEATING RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2900
Practice Address - Country:US
Practice Address - Phone:662-578-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSD7488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist