Provider Demographics
NPI:1700932597
Name:WOOD, ANGELA
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:395 RICHARDSON LN
Mailing Address - Street 2:
Mailing Address - City:MC EWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101-4325
Mailing Address - Country:US
Mailing Address - Phone:931-209-2594
Mailing Address - Fax:
Practice Address - Street 1:104 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2034
Practice Address - Country:US
Practice Address - Phone:615-446-8396
Practice Address - Fax:615-446-7770
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14108183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician