Provider Demographics
NPI:1033132535
Name:WOODWARD, PHILLIP MARCUS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MARCUS
Last Name:WOODWARD
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 1:11053 FOLKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-8051
Mailing Address - Country:US
Mailing Address - Phone:405-373-1983
Mailing Address - Fax:405-373-9230
Practice Address - Street 1:11053 FOLKSTONE DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-8051
Practice Address - Country:US
Practice Address - Phone:405-373-1983
Practice Address - Fax:405-373-9230
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8347183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist