Provider Demographics
NPI:1013029537
Name:WOODSBORO PHARMACY INC
Entity Type:Organization
Organization Name:WOODSBORO PHARMACY INC
Other - Org Name:VILLAGE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:361-526-4243
Mailing Address - Street 1:112 S ALAMO ST
Mailing Address - Street 2:
Mailing Address - City:REFUGIO
Mailing Address - State:TX
Mailing Address - Zip Code:78377-2338
Mailing Address - Country:US
Mailing Address - Phone:361-526-4243
Mailing Address - Fax:361-526-2031
Practice Address - Street 1:112 S ALAMO ST
Practice Address - Street 2:
Practice Address - City:REFUGIO
Practice Address - State:TX
Practice Address - Zip Code:78377-2338
Practice Address - Country:US
Practice Address - Phone:361-526-4243
Practice Address - Fax:361-526-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX061943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142083Medicaid
TX4533952OtherNCPDP
TX142083Medicaid