Healthcare Provider Details

I. General information

NPI: 1003805862
Provider Name (Legal Business Name): WOODS DRUG STORE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W MAIN ST
CHARLESTON MS
38921-2232
US

IV. Provider business mailing address

315 W MAIN ST
CHARLESTON MS
38921-2232
US

V. Phone/Fax

Practice location:
  • Phone: 662-647-5541
  • Fax: 662-647-5546
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00528
License Number StateMS

VIII. Authorized Official

Name: VICTOR BAILEY
Title or Position: CO OWNER PHARMACIST
Credential: RPH
Phone: 662-647-5541