Healthcare Provider Details

I. General information

NPI: 1316285026
Provider Name (Legal Business Name): LISA J WOODRUFF RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 MAIN ST
BELMAR NJ
07719-2723
US

IV. Provider business mailing address

911 MAIN ST
BELMAR NJ
07719-2723
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-1600
  • Fax: 732-280-1666
Mailing address:
  • Phone: 732-280-1600
  • Fax: 732-280-1666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI01883800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number032269-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: