MEDICARE: WOODWARD RX LLC

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	3336C0003X	Community/Retail Pharmacy	5301010811	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	FSRX3519444	OTHER		FLEXSCRIPT

General Provider Information

NPI Number	:	1376055079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODWARD RX LLC

Provider Business Mailing Address
First Line	:	6689 ORCHARD LAKE RD STE 168
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 WOODWARD AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-1890
Country	:	US
Telephone Number	:	313-832-5800
Fax Number	:	313-832-5802

Authorized Official
Title or Position	:	3RD PARTY COORDINATOR
Name	:	CANDICE TOLF
Credential	:
Telephone Number	:	313-751-7979

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	09/20/2023

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Directions to “WOODWARD RX LLC ” Practice Location

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