Provider Demographics
NPI:1982374260
Name:WOODYS DOWNTOWN PHARMACY LLC
Entity type:Organization
Organization Name:WOODYS DOWNTOWN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WOODY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:678-316-3031
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0007
Mailing Address - Country:US
Mailing Address - Phone:706-867-3784
Mailing Address - Fax:
Practice Address - Street 1:406 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0529
Practice Address - Country:US
Practice Address - Phone:706-867-3784
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy