Provider Demographics
NPI:1467930099
Name:WOOD, TIM (RPH)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:
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 1:23336 MONROE ROAD 1131
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MO
Mailing Address - Zip Code:65263-2037
Mailing Address - Country:US
Mailing Address - Phone:660-651-3541
Mailing Address - Fax:
Practice Address - Street 1:705 E BRIGGS DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1906
Practice Address - Country:US
Practice Address - Phone:660-385-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist