Provider Demographics
NPI:1164567657
Name:SHULTZ, WOODY GREER (RPH)
Entity Type:Individual
Prefix:
First Name:WOODY
Middle Name:GREER
Last Name:SHULTZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 S DR J B RIGGS DR
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-1824
Mailing Address - Country:US
Mailing Address - Phone:154-729-3092
Mailing Address - Fax:254-729-3999
Practice Address - Street 1:404 S DR J B RIGGS DR
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-1824
Practice Address - Country:US
Practice Address - Phone:154-729-3092
Practice Address - Fax:254-729-3999
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141468Medicaid
TX4521438OtherNCDPD NO.