Provider Demographics
NPI:1275544850
Name:WOODRUFF DRUG CO. P.A.
Entity Type:Organization
Organization Name:WOODRUFF DRUG CO. P.A.
Other - Org Name:FOOD GIANT DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-578-3277
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72432-0447
Mailing Address - Country:US
Mailing Address - Phone:870-578-3277
Mailing Address - Fax:
Practice Address - Street 1:605 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:AR
Practice Address - Zip Code:72432-1249
Practice Address - Country:US
Practice Address - Phone:870-578-3277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
ARAR20015333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR142420716DMEMedicaid
0419134OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AR130686407Medicaid
AR130686407Medicaid