Provider Demographics
NPI:1588802748
Name:WOODS SUPERMARKET INC
Entity Type:Organization
Organization Name:WOODS SUPERMARKET INC
Other - Org Name:WOODS PHARMACY 2473
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:PUSHPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANDARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-326-7603
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:703 E. COLLEGE
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-0880
Mailing Address - Country:US
Mailing Address - Phone:417-326-7603
Mailing Address - Fax:417-326-7609
Practice Address - Street 1:1109 SOUTH ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785-9456
Practice Address - Country:US
Practice Address - Phone:417-276-3670
Practice Address - Fax:417-276-3675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090015303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2118698OtherPK
MO606406809Medicaid