Provider Demographics
NPI:1700402237
Name:WOODLAND CARE PHARMACY AND MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:WOODLAND CARE PHARMACY AND MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARUNA
Authorized Official - Middle Name:NGBO
Authorized Official - Last Name:MADAKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:530-402-1455
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-1722
Mailing Address - Country:US
Mailing Address - Phone:530-402-1455
Mailing Address - Fax:530-402-1542
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1722
Practice Address - Country:US
Practice Address - Phone:530-402-1455
Practice Address - Fax:530-402-1542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-20
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy