Provider Demographics
NPI:1568283182
Name:WOODS, DEREK KENT (PHARMD)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:KENT
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 1:1213 W MOUNTAIN HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:FORT COBB
Mailing Address - State:OK
Mailing Address - Zip Code:73038
Mailing Address - Country:US
Mailing Address - Phone:580-481-8082
Mailing Address - Fax:
Practice Address - Street 1:2315 N PERKINS RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075
Practice Address - Country:US
Practice Address - Phone:405-564-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist