Provider Demographics
NPI:1306426697
Name:WOOD HERMANN, MICAH ANGELA
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:ANGELA
Last Name:WOOD HERMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 ROSEWOOD AVE APT A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2267
Mailing Address - Country:US
Mailing Address - Phone:832-492-0965
Mailing Address - Fax:
Practice Address - Street 1:2200 ROSEWOOD AVE APT A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2267
Practice Address - Country:US
Practice Address - Phone:832-492-0965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231018183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX231018OtherREGISTERED PHARMACY TECHNICIAN
205509883894OtherBLS PROVIDER