Provider Demographics
NPI:1902184088
Name:WOODYARD, JAMIE LYN SHELLY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYN SHELLY
Last Name:WOODYARD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4296 REGATTA DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-8473
Mailing Address - Country:US
Mailing Address - Phone:815-210-6169
Mailing Address - Fax:
Practice Address - Street 1:1400 W STATE STREET, BLDG. B, SUITE C
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906
Practice Address - Country:US
Practice Address - Phone:765-494-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist