MEDICARE: MR. LARRY WOODWARD W WOODWARD DPH,RPH

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	1835P1200X	Pharmacotherapy Pharmacist	10358	TN
2	1835P1200X	Pharmacotherapy Pharmacist	6970	AL

General Provider Information

NPI Number	:	1861499774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LARRY WOODWARD W WOODWARD DPH,RPH

Provider Business Mailing Address
First Line	:	87 PARKRIDGE CIR
Second Line	:
City	:	WINCHESTER
State	:	TN
Zip	:	37398-3791
Country	:	US
Telephone Number	:	256-508-0916
Fax Number	:	256-922-0424

Provider Business Practice Location Address
First Line	:	87 PARKRIDGE CIR
Second Line	:
City	:	WINCHESTER
State	:	TN
Zip	:	37398-3791
Country	:	US
Telephone Number	:	256-508-0916
Fax Number	:	256-922-0424

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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