Healthcare Provider Details

I. General information

NPI: 1437648342
Provider Name (Legal Business Name): WOODWARD CJS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2018
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E EDWARDSVILLE RD
WOOD RIVER IL
62095-1823
US

IV. Provider business mailing address

901 E EDWARDSVILLE RD
WOOD RIVER IL
62095-1823
US

V. Phone/Fax

Practice location:
  • Phone: 618-259-0085
  • Fax: 618-259-0089
Mailing address:
  • Phone: 618-259-0085
  • Fax: 618-259-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number054015916
License Number StateIL

VIII. Authorized Official

Name: JILL WOODWARD
Title or Position: OWNER/PIC
Credential:
Phone: 618-259-0085