Provider Demographics
NPI:1306974456
Name:WOODS, JONATHAN RYAN (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:RYAN
Last Name:WOODS
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 458
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:VA
Mailing Address - Zip Code:24280-0458
Mailing Address - Country:US
Mailing Address - Phone:276-880-9295
Mailing Address - Fax:
Practice Address - Street 1:RR 5 BOX 20
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-9611
Practice Address - Country:US
Practice Address - Phone:276-935-8718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202206569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist