Healthcare Provider Details

I. General information

NPI: 1720608508
Provider Name (Legal Business Name): BRANDON LEE WOODS CPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 DIVISION AVE
EUGENE OR
97404-5127
US

IV. Provider business mailing address

2417 LAKEVIEW DR APT 202
EUGENE OR
97408-4513
US

V. Phone/Fax

Practice location:
  • Phone: 541-461-1433
  • Fax: 541-461-1443
Mailing address:
  • Phone: 541-908-6016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberCPT-0008396
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: