Provider Demographics
NPI:1285235796
Name:WOODS, DOUGLAS (PHARMD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:WOODS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3974 S HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-7832
Mailing Address - Country:US
Mailing Address - Phone:405-326-4707
Mailing Address - Fax:
Practice Address - Street 1:3100 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-9585
Practice Address - Country:US
Practice Address - Phone:405-258-2012
Practice Address - Fax:405-258-3095
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist