Provider Demographics
NPI:1033425541
Name:WOOD, JERRY (R PH)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 W WADLEY AVE
Mailing Address - Street 2:4202 RUSSELL DR.
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5714
Mailing Address - Country:US
Mailing Address - Phone:432-697-8604
Mailing Address - Fax:
Practice Address - Street 1:3325 W WADLEY AVE
Practice Address - Street 2:4202 RUSSELL DR.
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5714
Practice Address - Country:US
Practice Address - Phone:432-697-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist