Provider Demographics
NPI:1134403413
Name:WOODBURY, CARLTON JEROME (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:CARLTON
Middle Name:JEROME
Last Name:WOODBURY
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13811 FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6842
Mailing Address - Country:US
Mailing Address - Phone:301-780-3171
Mailing Address - Fax:
Practice Address - Street 1:9001 WOODY TER
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4255
Practice Address - Country:US
Practice Address - Phone:301-856-6501
Practice Address - Fax:301-856-6507
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14325183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist