Provider Demographics
NPI:1275818932
Name:WOOD, SHARONDA F
Entity Type:Individual
Prefix:
First Name:SHARONDA
Middle Name:F
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4724
Mailing Address - Country:US
Mailing Address - Phone:201-243-1804
Mailing Address - Fax:201-243-9653
Practice Address - Street 1:699 BROADWAY
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-4724
Practice Address - Country:US
Practice Address - Phone:201-243-1804
Practice Address - Fax:201-243-9653
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW00430600183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician