Healthcare Provider Details

I. General information

NPI: 1841544129
Provider Name (Legal Business Name): TODD WOODARD PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 COTILLION DR APT 2114
ATLANTA GA
30338-7881
US

IV. Provider business mailing address

1850 COTILLION DR APT 2114
ATLANTA GA
30338-7881
US

V. Phone/Fax

Practice location:
  • Phone: 678-856-7923
  • Fax:
Mailing address:
  • Phone: 678-856-7923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRPH023312
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS41232
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: