Provider Demographics
NPI:1740420504
Name:WOODFORD, DAVID (PHD BS PHARM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:WOODFORD
Suffix:
Gender:M
Credentials:PHD BS PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 GRANGER ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-2522
Mailing Address - Country:US
Mailing Address - Phone:617-471-1669
Mailing Address - Fax:
Practice Address - Street 1:143 GRANGER ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-2522
Practice Address - Country:US
Practice Address - Phone:617-471-1669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist