Provider Demographics
NPI:1720608508
Name:WOODS, BRANDON LEE (CPHT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:LEE
Last Name:WOODS
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 LAKEVIEW DR APT 202
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-4513
Mailing Address - Country:US
Mailing Address - Phone:541-908-6016
Mailing Address - Fax:
Practice Address - Street 1:60 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-5127
Practice Address - Country:US
Practice Address - Phone:541-461-1433
Practice Address - Fax:541-461-1443
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPT-0008396183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician