MEDICARE: DR. JOHNATHEN WOODWARD PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	20551	NV

General Provider Information

NPI Number	:	1336767797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHNATHEN WOODWARD PHARMD

Provider Business Mailing Address
First Line	:	1005 WIGWAM PKWY APT 1206
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-8248
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 N NELLIS BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-5304
Country	:	US
Telephone Number	:	702-452-0224
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2020
Last Update Date	:	07/10/2020

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Directions to “ DR. JOHNATHEN WOODWARD PHARMD” Practice Location

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