Provider Demographics
NPI:1629684188
Name:WOOD, EMILY ROSE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:LINDSEY
Mailing Address - State:OH
Mailing Address - Zip Code:43442-0367
Mailing Address - Country:US
Mailing Address - Phone:419-577-9974
Mailing Address - Fax:
Practice Address - Street 1:226 E PERKINS AVE
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-4905
Practice Address - Country:US
Practice Address - Phone:419-239-2624
Practice Address - Fax:419-239-2628
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034401721835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist