Provider Demographics
NPI:1558709840
Name:WOODMOOR PHARMACY AND MEDICAL SUPPLY.
Entity Type:Organization
Organization Name:WOODMOOR PHARMACY AND MEDICAL SUPPLY.
Other - Org Name:WOODMOOR PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GODFREY,
Authorized Official - Middle Name:
Authorized Official - Last Name:UKWUOMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MBA
Authorized Official - Phone:410-448-4200
Mailing Address - Street 1:7027 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5802
Mailing Address - Country:US
Mailing Address - Phone:410-448-4200
Mailing Address - Fax:410-448-4202
Practice Address - Street 1:7027 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5802
Practice Address - Country:US
Practice Address - Phone:410-448-4200
Practice Address - Fax:410-448-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2140740OtherPK