Healthcare Provider Details

I. General information

NPI: 1396759445
Provider Name (Legal Business Name): WOODWARD - CJS PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/07/2023
Certification Date:
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:
Mailing address:
  • Phone: 618-259-0085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number054015916
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05415916
License Number StateIL

VIII. Authorized Official

Name: DR. JILL WOODWARD
Title or Position: OWNER/PRESIDENT
Credential: PHARMD
Phone: 618-259-0085