Provider Demographics
NPI:1841298502
Name:WOOD, WILLIAM GREGORY (RPH, CDE)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GREGORY
Last Name:WOOD
Suffix:
Gender:M
Credentials:RPH, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4867 FLORIDA CLUB CIR APT 4211
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1090
Mailing Address - Country:US
Mailing Address - Phone:334-750-5521
Mailing Address - Fax:
Practice Address - Street 1:4867 FLORIDA CLUB CIR APT 4211
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1090
Practice Address - Country:US
Practice Address - Phone:334-750-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12939183500000X
FL31383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12939OtherALABAMA PHARMACIST
FL31383OtherPHARMACIST LICENSE
AL12939OtherPRECEPTOR
AL12939OtherPHARMACIST CONSULTANT
AL51029540WILMedicare ID - Type UnspecifiedIMMUNIZATION PROVIDER
AL12939OtherPHARMACIST CONSULTANT