Provider Demographics
NPI:1437572328
Name:WOODHAM, TERRI CARDENAS
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:CARDENAS
Last Name:WOODHAM
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 1:336 HIGHWAY 9 WEST
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-2501
Mailing Address - Country:US
Mailing Address - Phone:843-479-0029
Mailing Address - Fax:843-479-0031
Practice Address - Street 1:336 HIGHWAY 9 WEST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512
Practice Address - Country:US
Practice Address - Phone:843-479-0029
Practice Address - Fax:843-479-0031
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist