Provider Demographics
NPI:1659688919
Name:WOOD, WYATT AUSTIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:WYATT
Middle Name:AUSTIN
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 N 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-9456
Mailing Address - Country:US
Mailing Address - Phone:509-576-6833
Mailing Address - Fax:509-576-6827
Practice Address - Street 1:1206 N 40TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-9456
Practice Address - Country:US
Practice Address - Phone:509-576-6833
Practice Address - Fax:509-576-6827
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 00071722183500000X
ORRPH-0009813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist