Provider Demographics
NPI:1932207800
Name:WOODARD DRUG STORE INC
Entity Type:Organization
Organization Name:WOODARD DRUG STORE INC
Other - Org Name:WOODARD DRUG STORE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-936-3151
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569-0005
Mailing Address - Country:US
Mailing Address - Phone:919-936-3151
Mailing Address - Fax:919-936-3015
Practice Address - Street 1:102 E EDWARDS ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NC
Practice Address - Zip Code:27569-7279
Practice Address - Country:US
Practice Address - Phone:919-936-3151
Practice Address - Fax:919-936-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
NC070973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066643OtherPK
NC0515098Medicaid
2066643OtherPK