Provider Demographics
NPI:1982928800
Name:WOODLAND PHARMACY CO
Entity Type:Organization
Organization Name:WOODLAND PHARMACY CO
Other - Org Name:WOODLAND PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HACHMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-387-1700
Mailing Address - Street 1:22341 W 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-1217
Mailing Address - Country:US
Mailing Address - Phone:313-387-1700
Mailing Address - Fax:313-387-1704
Practice Address - Street 1:22341 W 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-1217
Practice Address - Country:US
Practice Address - Phone:313-387-1700
Practice Address - Fax:313-387-1704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010093143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2124529OtherPK