Provider Demographics
NPI:1972011021
Name:WOOD, SOUICHI (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SOUICHI
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2541 NW EDENBOWER BLVD APT 113
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-8814
Mailing Address - Country:US
Mailing Address - Phone:808-227-7567
Mailing Address - Fax:
Practice Address - Street 1:1539 NE STEPHENS ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1563
Practice Address - Country:US
Practice Address - Phone:541-957-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0016383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist