Provider Demographics
NPI:1568774487
Name:WOOD, SELMA (DPH/RPH)
Entity Type:Individual
Prefix:DR
First Name:SELMA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:DPH/RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13533 JONES GAP RD
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-8535
Mailing Address - Country:US
Mailing Address - Phone:423-332-3988
Mailing Address - Fax:
Practice Address - Street 1:5478 HIGHWAY 153
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-3782
Practice Address - Country:US
Practice Address - Phone:423-875-0855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC007469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist