Provider Demographics
NPI:1407162449
Name:WOOD, GREG LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:LYNN
Last Name:WOOD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 BARNES CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-0910
Mailing Address - Country:US
Mailing Address - Phone:662-844-5247
Mailing Address - Fax:662-844-5417
Practice Address - Street 1:930 BARNES CROSSING RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-0910
Practice Address - Country:US
Practice Address - Phone:662-844-5247
Practice Address - Fax:662-844-5417
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST08172183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist