Provider Demographics
NPI:1588792774
Name:WOOD, DEBORAH LEAH (PHARMACIST)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:LEAH
Last Name:WOOD
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 E 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3070
Mailing Address - Country:US
Mailing Address - Phone:303-678-7639
Mailing Address - Fax:
Practice Address - Street 1:557 BURBANK ST
Practice Address - Street 2:SUITE Q
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7160
Practice Address - Country:US
Practice Address - Phone:303-460-9414
Practice Address - Fax:303-460-0850
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14003183500000X
FL14153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14003OtherPHARMACIST LICENSE NUMBER