Provider Demographics
NPI:1760764633
Name:WOODARD, ADAM GLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:GLEN
Last Name:WOODARD
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 1:10412 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1233
Mailing Address - Country:US
Mailing Address - Phone:260-637-0848
Mailing Address - Fax:
Practice Address - Street 1:10412 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1233
Practice Address - Country:US
Practice Address - Phone:260-637-0848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023755A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist