Healthcare Provider Details

I. General information

NPI: 1740420504
Provider Name (Legal Business Name): DAVID WOODFORD PHD BS PHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 GRANGER ST
QUINCY MA
02170-2522
US

IV. Provider business mailing address

143 GRANGER ST
QUINCY MA
02170-2522
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-1669
  • Fax:
Mailing address:
  • Phone: 617-471-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18367
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: