Provider Demographics
NPI:1164019337
Name:WOODEN, JEFFERY RYAN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:RYAN
Last Name:WOODEN
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 1:60 MARKET CENTER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7077
Mailing Address - Country:US
Mailing Address - Phone:901-316-5752
Mailing Address - Fax:901-316-5760
Practice Address - Street 1:60 MARKET CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-7077
Practice Address - Country:US
Practice Address - Phone:901-316-5752
Practice Address - Fax:901-316-5760
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist