1235226762 NPI number — MS. CARDYON ONETA MITCHELL WOODARD LICENSED DISPENSER

Table of content: MS. CARDYON ONETA MITCHELL WOODARD LICENSED DISPENSER (NPI 1235226762)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235226762 NPI number — MS. CARDYON ONETA MITCHELL WOODARD LICENSED DISPENSER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODARD
Provider First Name:
CARDYON
Provider Middle Name:
ONETA MITCHELL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED DISPENSER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235226762
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5303 50TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-799-8950
Provider Business Mailing Address Fax Number:
806-792-9404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 COULTER
Provider Second Line Business Practice Location Address:
BLDG A STE 105
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-352-2321
Provider Business Practice Location Address Fax Number:
806-355-8941
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  50197 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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