Provider Demographics
NPI:1629014857
Name:WOOD PHARMACY
Entity Type:Organization
Organization Name:WOOD PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-253-8050
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:MONON
Mailing Address - State:IN
Mailing Address - Zip Code:47959-0807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:326 N MARKET
Practice Address - Street 2:
Practice Address - City:MONON
Practice Address - State:IN
Practice Address - Zip Code:47959
Practice Address - Country:US
Practice Address - Phone:219-253-8050
Practice Address - Fax:219-253-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN60004975A3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1533062OtherOTHER ID NUMBER
IN100296370AMedicaid
IN100296370AMedicaid