Provider Demographics
NPI:1780781179
Name:WOODY, RYAN ALLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ALLEN
Last Name:WOODY
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 HILLERY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COMANCHE
Mailing Address - State:OK
Mailing Address - Zip Code:73529-1200
Mailing Address - Country:US
Mailing Address - Phone:580-439-8869
Mailing Address - Fax:580-439-2357
Practice Address - Street 1:513 HILLERY RD
Practice Address - Street 2:SUITE B
Practice Address - City:COMANCHE
Practice Address - State:OK
Practice Address - Zip Code:73529-1200
Practice Address - Country:US
Practice Address - Phone:580-439-8869
Practice Address - Fax:580-439-2357
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100238060AMedicaid