Provider Demographics
NPI:1588989982
Name:WOOD, RONALD
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:WOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SOUTHDOWN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2538
Mailing Address - Country:US
Mailing Address - Phone:631-427-6262
Mailing Address - Fax:631-421-1220
Practice Address - Street 1:25 SOUTHDOWN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2538
Practice Address - Country:US
Practice Address - Phone:631-427-6262
Practice Address - Fax:631-421-1220
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist