Provider Demographics
NPI:1699374868
Name:WOODY, RON (RPH)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:WOODY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W CEDAR CREEK PKWY # A1
Mailing Address - Street 2:
Mailing Address - City:SEVEN POINTS
Mailing Address - State:TX
Mailing Address - Zip Code:75143-8087
Mailing Address - Country:US
Mailing Address - Phone:903-432-3494
Mailing Address - Fax:903-432-2578
Practice Address - Street 1:205 W CEDAR CREEK PKWY # A1
Practice Address - Street 2:
Practice Address - City:SEVEN POINTS
Practice Address - State:TX
Practice Address - Zip Code:75143-8087
Practice Address - Country:US
Practice Address - Phone:903-432-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist