Provider Demographics
NPI:1013410190
Name:WOOD, CARL EDWARD
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:EDWARD
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2128
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-2128
Mailing Address - Country:US
Mailing Address - Phone:209-742-5550
Mailing Address - Fax:209-742-5551
Practice Address - Street 1:5034 COAKLEY CIRCLE
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-9533
Practice Address - Country:US
Practice Address - Phone:209-742-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28161183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist