Healthcare Provider Details

I. General information

NPI: 1144317058
Provider Name (Legal Business Name): WOODS DRUG STORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S MAIN ST
HOPKINSVILLE KY
42240-2112
US

IV. Provider business mailing address

808 S MAIN ST P.O. BOX 4
HOPKINSVILLE KY
42240-2112
US

V. Phone/Fax

Practice location:
  • Phone: 270-885-5341
  • Fax: 270-885-5737
Mailing address:
  • Phone: 270-885-5341
  • Fax: 270-885-5737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberP06837
License Number StateKY

VIII. Authorized Official

Name: GEORGE B. COFFEEN
Title or Position: OWNER
Credential: RPH
Phone: 270-885-5341