Provider Demographics
NPI:1720477169
Name:WOODBURY, WAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:WOODBURY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 BADGER CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-1400
Mailing Address - Country:US
Mailing Address - Phone:980-236-8661
Mailing Address - Fax:
Practice Address - Street 1:10030 GILEAD RD STE 290
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7545
Practice Address - Country:US
Practice Address - Phone:704-659-7848
Practice Address - Fax:877-881-8455
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16693183500000X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No183500000XPharmacy Service ProvidersPharmacist