Healthcare Provider Details

I. General information

NPI: 1972897486
Provider Name (Legal Business Name): CAMILLA REBECCA WOODARD PHARM.D, RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2011
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST NORTHWEST PAVILLION
RENTON WA
98055-5714
US

IV. Provider business mailing address

1020 NE 125TH ST #17
SEATTLE WA
98125-4073
US

V. Phone/Fax

Practice location:
  • Phone: 425-228-3440
  • Fax:
Mailing address:
  • Phone: 253-797-6726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH60220978
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: