Provider Demographics
NPI:1003531369
Name:WOOD, ALEXANDER FRED (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:FRED
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2736
Mailing Address - Country:US
Mailing Address - Phone:913-220-9521
Mailing Address - Fax:
Practice Address - Street 1:14805 N OUTER 40 RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-6021
Practice Address - Country:US
Practice Address - Phone:636-733-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110237111835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric