Healthcare Provider Details

I. General information

NPI: 1902396567
Provider Name (Legal Business Name): DR. DANELLE WOODARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BLUEMONT AVE
MANHATTAN KS
66502-5093
US

IV. Provider business mailing address

5275 MARLATT AVE
MANHATTAN KS
66503-8145
US

V. Phone/Fax

Practice location:
  • Phone: 785-776-4841
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1-13919
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: