Healthcare Provider Details

I. General information

NPI: 1629089289
Provider Name (Legal Business Name): WOODMARK PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 WEHRLE DR
WILLIAMSVILLE NY
14221-7748
US

IV. Provider business mailing address

1142 WEHRLE DR
WILLIAMSVILLE NY
14221-7748
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-3381
  • Fax: 716-631-3097
Mailing address:
  • Phone: 716-631-3381
  • Fax: 716-631-3097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number031869
License Number StateNY

VIII. Authorized Official

Name: STACY JOHNSON
Title or Position: SUPERVISING PHARMACIST
Credential:
Phone: 716-631-3381