Provider Demographics
NPI:1245395672
Name:WOODLAWN PHARMACEUTICAL GROUP INC
Entity Type:Organization
Organization Name:WOODLAWN PHARMACEUTICAL GROUP INC
Other - Org Name:WOODLAWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & P.I.C.
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSUDI
Authorized Official - Middle Name:MUHAMMED
Authorized Official - Last Name:ADEGBINDIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:713-928-3044
Mailing Address - Street 1:2215 ROLLINGBROOK DRIVE
Mailing Address - Street 2:STE 120A
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521
Mailing Address - Country:US
Mailing Address - Phone:713-928-3044
Mailing Address - Fax:713-947-8081
Practice Address - Street 1:2215 ROLLINGBROOK DRIVE
Practice Address - Street 2:STE 120A
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521
Practice Address - Country:US
Practice Address - Phone:713-928-3044
Practice Address - Fax:713-947-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098351OtherPK
TX148092Medicaid