Provider Demographics
NPI:1811069446
Name:WOODS, DAVID B (PD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:WOODS
Suffix:
Gender:M
Credentials:PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 WAKEROBIN RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-8143
Mailing Address - Country:US
Mailing Address - Phone:479-490-4674
Mailing Address - Fax:
Practice Address - Street 1:1808 W MAIN ST
Practice Address - Street 2:SMRMC PHARMACY DEPARTMENT
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2724
Practice Address - Country:US
Practice Address - Phone:479-964-9164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist