Provider Demographics
NPI:1164806337
Name:WOODS, ROBERT R (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:WOODS
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 1:1501 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4027
Mailing Address - Country:US
Mailing Address - Phone:601-482-4003
Mailing Address - Fax:601-482-3948
Practice Address - Street 1:1501 23RD AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4027
Practice Address - Country:US
Practice Address - Phone:601-482-4003
Practice Address - Fax:601-482-3948
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE13976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist