Healthcare Provider Details

I. General information

NPI: 1609730852
Provider Name (Legal Business Name): DESTINEE WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 MOUND ST
JONESVILLE LA
71343-2319
US

IV. Provider business mailing address

114 CATAHOULA ST
JONESVILLE LA
71343-2755
US

V. Phone/Fax

Practice location:
  • Phone: 318-339-7913
  • Fax:
Mailing address:
  • Phone: 318-535-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number026050
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: