MEDICARE: WOODSON PHARMACY 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

General Provider Information

NPI Number	:	1710643762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODSON PHARMACY LLC

Provider Business Mailing Address
First Line	:	3028 E WOODSON LATERAL RD
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9169
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3028 E WOODSON LATERAL RD
Second Line	:
City	:	HENSLEY
State	:	AR
Zip	:	72065-9169
Country	:	US
Telephone Number	:	501-486-4128
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SYED HAIDER
Credential	:
Telephone Number	:	636-579-1085

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	05/19/2023

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Directions to “WOODSON PHARMACY LLC ” Practice Location

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