Provider Demographics
NPI:1568502003
Name:NORTHWOOD PHARMACY INC
Entity Type:Organization
Organization Name:NORTHWOOD PHARMACY INC
Other - Org Name:NORTHWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KYLES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:713-633-3600
Mailing Address - Street 1:9999 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77016-3725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9999 HOMESTEAD RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77016-3725
Practice Address - Country:US
Practice Address - Phone:713-633-3600
Practice Address - Fax:713-633-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX237783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4529864OtherOTHER ID NUMBER
TX1273520Medicaid
4529864OtherOTHER ID NUMBER-COMMERCIAL NUMBER
TX145489Medicaid