Provider Demographics
NPI:1811591621
Name:WOOD, ELLEN ELAINE (RPH)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:ELAINE
Last Name:WOOD
Suffix:
Gender:F
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:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:OK
Mailing Address - Zip Code:74432-0288
Mailing Address - Country:US
Mailing Address - Phone:405-323-4828
Mailing Address - Fax:
Practice Address - Street 1:605 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HENRYETTA
Practice Address - State:OK
Practice Address - Zip Code:74437-4439
Practice Address - Country:US
Practice Address - Phone:918-652-9447
Practice Address - Fax:918-652-8802
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25165183500000X
MT6373183500000X
OK10022183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist