Provider Demographics
NPI:1831838176
Name:WOODWARD PHARMACY MANAGEMENT, PC
Entity type:Organization
Organization Name:WOODWARD PHARMACY MANAGEMENT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUENERGARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:580-254-3504
Mailing Address - Street 1:2116 OKLAHOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-4258
Mailing Address - Country:US
Mailing Address - Phone:580-254-3504
Mailing Address - Fax:580-256-6359
Practice Address - Street 1:2116 OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-4258
Practice Address - Country:US
Practice Address - Phone:580-254-3504
Practice Address - Fax:580-256-6359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy