Provider Demographics
NPI:1558556555
Name:WOODRUFF DRUG CO P.A.
Entity Type:Organization
Organization Name:WOODRUFF DRUG CO P.A.
Other - Org Name:FOOD GIANT DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:C
Authorized Official - Last Name:WOODRUFF
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-578-3277
Mailing Address - Street 1:605 N ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72432-1249
Mailing Address - Country:US
Mailing Address - Phone:870-578-3277
Mailing Address - Fax:870-578-9620
Practice Address - Street 1:605 N ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:AR
Practice Address - Zip Code:72432-1249
Practice Address - Country:US
Practice Address - Phone:870-578-3277
Practice Address - Fax:870-578-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR20015332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR3905640001Medicare NSC