Healthcare Provider Details

I. General information

NPI: 1982022406
Provider Name (Legal Business Name): WOODROW STOREY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 UNSER BLVD NW
ALBUQUERQUE NM
87114-4640
US

IV. Provider business mailing address

10700 UNSER BLVD NW
ALBUQUERQUE NM
87114-4640
US

V. Phone/Fax

Practice location:
  • Phone: 505-792-1992
  • Fax: 505-792-1990
Mailing address:
  • Phone: 505-792-1992
  • Fax: 505-792-1990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5070
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: