Provider Demographics
NPI:1083325559
Name:WOODARD, TOMMY JOE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:JOE
Last Name:WOODARD
Suffix:JR
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 1:6251 PERKINS RD STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4167
Mailing Address - Country:US
Mailing Address - Phone:225-389-6251
Mailing Address - Fax:225-389-6277
Practice Address - Street 1:6251 PERKINS RD STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4167
Practice Address - Country:US
Practice Address - Phone:225-389-6251
Practice Address - Fax:225-389-6277
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.0182313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPST.018231OtherOTHER