Provider Demographics
NPI:1528736352
Name:WOODYARD, ANTHONY WAYNE (CPHT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:WAYNE
Last Name:WOODYARD
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 NORTH DR APT C
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-2052
Mailing Address - Country:US
Mailing Address - Phone:540-599-6344
Mailing Address - Fax:
Practice Address - Street 1:590 NORTH DR APT C
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-2052
Practice Address - Country:US
Practice Address - Phone:540-599-6344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230033245183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician