1629014857 NPI number — WOOD PHARMACY

Table of content: BRYANA MERRELL M.S., CCC-SLP (NPI 1699224501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629014857 NPI number — WOOD PHARMACY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOOD PHARMACY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1629014857
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47959-0807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
326 N MARKET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-253-8050
Provider Business Practice Location Address Fax Number:
219-253-8283
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOOD
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
219-253-8050

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  60004975A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1533062 . This is a "OTHER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100296370A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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