Healthcare Provider Details

I. General information

NPI: 1780075945
Provider Name (Legal Business Name): PATRICIA WOODS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2490 N FAIRFIELD RD
BEAVERCREEK OH
45431-1787
US

IV. Provider business mailing address

2490 N FAIRFIELD RD
BEAVERCREEK OH
45431-1787
US

V. Phone/Fax

Practice location:
  • Phone: 937-431-8672
  • Fax: 937-306-4594
Mailing address:
  • Phone: 937-431-8672
  • Fax: 937-306-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberD4X5L6A7
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: