Provider Demographics
NPI:1851988224
Name:WOODALL, DANNY MIKE (RPH)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:MIKE
Last Name:WOODALL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 EDWARDS
Mailing Address - Street 2:
Mailing Address - City:MERKEL
Mailing Address - State:TX
Mailing Address - Zip Code:79536-3801
Mailing Address - Country:US
Mailing Address - Phone:325-928-5012
Mailing Address - Fax:325-928-5912
Practice Address - Street 1:121 EDWARDS
Practice Address - Street 2:
Practice Address - City:MERKEL
Practice Address - State:TX
Practice Address - Zip Code:79536-3801
Practice Address - Country:US
Practice Address - Phone:325-928-5012
Practice Address - Fax:325-928-5912
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24632183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX24632OtherTEXAS STATE BOARD OF PHARMACY