Provider Demographics
NPI:1295867091
Name:WOODWARD RESOURCE CENTER PHARMACY
Entity Type:Organization
Organization Name:WOODWARD RESOURCE CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-438-3622
Mailing Address - Street 1:1251 334TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:IA
Mailing Address - Zip Code:50276-7509
Mailing Address - Country:US
Mailing Address - Phone:515-438-3121
Mailing Address - Fax:515-438-3122
Practice Address - Street 1:1251 334TH ST
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:IA
Practice Address - Zip Code:50276-7509
Practice Address - Country:US
Practice Address - Phone:515-438-3121
Practice Address - Fax:515-438-3122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODWARD RESOURCE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA9443336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1932563OtherNCPDP#
IA0880088Medicaid
IAAW4016235OtherDEA #