Provider Demographics
NPI:1205170073
Name:WOOD, KEVIN SCOTT (PHARMACIST)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:SCOTT
Last Name:WOOD
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2405
Mailing Address - Street 2:795 CUMMINGS STREET
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211
Mailing Address - Country:US
Mailing Address - Phone:276-258-5211
Mailing Address - Fax:276-258-5289
Practice Address - Street 1:795 CUMMINGS STREET
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211
Practice Address - Country:US
Practice Address - Phone:276-258-5251
Practice Address - Fax:276-258-5289
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202012264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist