Provider Demographics
NPI:1073632972
Name:WOODYS PHARMACY INC.
Entity Type:Organization
Organization Name:WOODYS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:423-626-3333
Mailing Address - Street 1:408 S BROAD ST
Mailing Address - Street 2:STE 2
Mailing Address - City:NEW TAZEWELL
Mailing Address - State:TN
Mailing Address - Zip Code:37825-7800
Mailing Address - Country:US
Mailing Address - Phone:423-626-3333
Mailing Address - Fax:423-626-5522
Practice Address - Street 1:408 S BROAD ST
Practice Address - Street 2:STE 2
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-7800
Practice Address - Country:US
Practice Address - Phone:423-626-3333
Practice Address - Fax:423-626-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000032903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN122015001OtherMEDICARE ID NUMBER
TN122015001Medicaid
TN4431881OtherNCPDP NUMBER
TN4431881OtherNABP NUMBER
TN4431881OtherNABP NUMBER