Provider Demographics
NPI:1639897085
Name:WOODSIDE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:WOODSIDE HEALTH SERVICES LLC
Other - Org Name:WOODSIDE LTC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:REFAAT
Authorized Official - Last Name:AHMED SALEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:219-286-3091
Mailing Address - Street 1:1551 STURDY RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-7883
Mailing Address - Country:US
Mailing Address - Phone:219-286-3091
Mailing Address - Fax:219-510-5268
Practice Address - Street 1:1551 STURDY RD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-7883
Practice Address - Country:US
Practice Address - Phone:219-286-3091
Practice Address - Fax:219-510-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy