Provider Demographics
NPI:1255617247
Name:WOOD, JILL DAVIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:DAVIS
Last Name:WOOD
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 1:27255 LEE HWY
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7517
Mailing Address - Country:US
Mailing Address - Phone:276-739-7748
Mailing Address - Fax:276-739-2328
Practice Address - Street 1:27255 LEE HWY
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7517
Practice Address - Country:US
Practice Address - Phone:276-739-7748
Practice Address - Fax:276-739-2328
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-23
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000036613183500000X
KY016298183500000X
VA0202207572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841857364Medicaid