Provider Demographics
NPI:1326104555
Name:WOODY'S PHARMACY, INC.
Entity Type:Organization
Organization Name:WOODY'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:770-983-3510
Mailing Address - Street 1:5226 DAHLONEGA HWY
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:GA
Mailing Address - Zip Code:30527-1900
Mailing Address - Country:US
Mailing Address - Phone:770-983-3510
Mailing Address - Fax:770-983-7986
Practice Address - Street 1:5226 DAHLONEGA HWY
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:GA
Practice Address - Zip Code:30527-1900
Practice Address - Country:US
Practice Address - Phone:770-983-3510
Practice Address - Fax:770-983-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE008579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00932698AMedicaid
GA00932698AMedicaid