Provider Demographics
NPI:1386746923
Name:WOOLMARKET PHARMACY, INC.
Entity type:Organization
Organization Name:WOOLMARKET PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:TRIPLETT
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:228-392-5355
Mailing Address - Street 1:13066 HIGHWAY 67 STE F
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-8616
Mailing Address - Country:US
Mailing Address - Phone:228-392-5355
Mailing Address - Fax:228-392-1620
Practice Address - Street 1:13066 HIGHWAY 67 STE F
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-8616
Practice Address - Country:US
Practice Address - Phone:228-392-5355
Practice Address - Fax:228-392-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04928/01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2520369OtherNCPDP/NABP NUMBER
MS00330581Medicaid
MS04928/01.1OtherPHRARMACY LICENSE
MS04928/01.1OtherPHRARMACY LICENSE