Provider Demographics
NPI:1013594274
Name:WOODSON, MICHELLE L (CPHT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WOODSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 ROSZELL ST APT 2201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2575
Mailing Address - Country:US
Mailing Address - Phone:361-876-4224
Mailing Address - Fax:
Practice Address - Street 1:11301 ROSZELL ST APT 2201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2575
Practice Address - Country:US
Practice Address - Phone:361-876-4224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician