Healthcare Provider Details

I. General information

NPI: 1326104555
Provider Name (Legal Business Name): WOODY'S PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5226 DAHLONEGA HWY
CLERMONT GA
30527-1900
US

IV. Provider business mailing address

5226 DAHLONEGA HWY
CLERMONT GA
30527-1900
US

V. Phone/Fax

Practice location:
  • Phone: 770-983-3510
  • Fax: 770-983-7986
Mailing address:
  • Phone: 770-983-3510
  • Fax: 770-983-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPHRE008579
License Number StateGA

VIII. Authorized Official

Name: MR. KEVIN JOSEPH WOODY
Title or Position: OWNER
Credential: RPH.
Phone: 770-983-3510