Healthcare Provider Details

I. General information

NPI: 1609148931
Provider Name (Legal Business Name): BRIAN J WOOD PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

423 BROOKSTONE DR
MADISON MS
39110-8835
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-4707
  • Fax:
Mailing address:
  • Phone: 601-720-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-010267
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberE-010267
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: