Provider Demographics
NPI:1780685099
Name:WOODARD DRUG INC.
Entity Type:Organization
Organization Name:WOODARD DRUG INC.
Other - Org Name:WOODARD DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PADGETT
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:870-356-2193
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:210 E. BROADWAY
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-1470
Mailing Address - Country:US
Mailing Address - Phone:870-356-2193
Mailing Address - Fax:870-356-3145
Practice Address - Street 1:210 E BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:AR
Practice Address - Zip Code:71943-9243
Practice Address - Country:US
Practice Address - Phone:870-356-2193
Practice Address - Fax:870-356-3145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR67913332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47920OtherBLUE CROSS/BLUE SHIELD
0235030001Medicare NSC