Provider Demographics
NPI:1942588934
Name:WOODWARD, HEYWARD JR (RPH)
Entity Type:Individual
Prefix:
First Name:HEYWARD
Middle Name:
Last Name:WOODWARD
Suffix:JR
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 1:1031 MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHEAD
Mailing Address - State:GA
Mailing Address - Zip Code:30625-2223
Mailing Address - Country:US
Mailing Address - Phone:706-342-9288
Mailing Address - Fax:
Practice Address - Street 1:2240 SALEM RD SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1843
Practice Address - Country:US
Practice Address - Phone:770-929-8711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist