Provider Demographics
NPI:1003801739
Name:WOODBRIDGE PHARMACY
Entity Type:Organization
Organization Name:WOODBRIDGE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ZAMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:209-365-9200
Mailing Address - Street 1:2401 W TURNER RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-2182
Mailing Address - Country:US
Mailing Address - Phone:209-365-9200
Mailing Address - Fax:209-365-9400
Practice Address - Street 1:2401 W TURNER RD
Practice Address - Street 2:SUITE 290
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-2182
Practice Address - Country:US
Practice Address - Phone:209-365-9200
Practice Address - Fax:209-365-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy