Provider Demographics
NPI:1003112376
Name:WOOD, ROGERS W JR (RPH)
Entity Type:Individual
Prefix:
First Name:ROGERS
Middle Name:W
Last Name:WOOD
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:54 E JARMAN ST
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539
Mailing Address - Country:US
Mailing Address - Phone:912-375-9893
Mailing Address - Fax:912-375-3214
Practice Address - Street 1:54 E JARMAN ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539
Practice Address - Country:US
Practice Address - Phone:912-375-9893
Practice Address - Fax:912-375-3214
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
461799980OtherUPDATED TAX ID