Provider Demographics
NPI:1467473421
Name:MELANIE L WOOD
Entity Type:Organization
Organization Name:MELANIE L WOOD
Other - Org Name:RAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-657-2588
Mailing Address - Street 1:220 ZEID BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-6068
Mailing Address - Country:US
Mailing Address - Phone:903-657-2588
Mailing Address - Fax:903-657-6246
Practice Address - Street 1:220 ZEID BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-6068
Practice Address - Country:US
Practice Address - Phone:903-657-2588
Practice Address - Fax:903-657-6246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201623336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144963Medicaid
2092664OtherPK
TX144963Medicaid