Provider Demographics
NPI:1811964190
Name:WOODSON'S PHARMACY, INC.
Entity type:Organization
Organization Name:WOODSON'S PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WOODSON
Authorized Official - Suffix:III
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:615-563-4542
Mailing Address - Street 1:304 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:TN
Mailing Address - Zip Code:37190-1125
Mailing Address - Country:US
Mailing Address - Phone:615-563-4542
Mailing Address - Fax:615-563-2845
Practice Address - Street 1:304 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:TN
Practice Address - Zip Code:37190-1125
Practice Address - Country:US
Practice Address - Phone:615-563-4542
Practice Address - Fax:615-563-2845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-04
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC1209333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9440040Medicaid
TN1211600001Medicare NSC