Healthcare Provider Details

I. General information

NPI: 1932180536
Provider Name (Legal Business Name): WILLIAM BRAD WOOD RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S MAIN ST
MOUNT GILEAD OH
43338-1445
US

IV. Provider business mailing address

5753 COUNTY ROAD 30
MOUNT GILEAD OH
43338-9701
US

V. Phone/Fax

Practice location:
  • Phone: 419-946-5911
  • Fax:
Mailing address:
  • Phone: 419-946-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03-2-11260
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: