=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225675978
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOODLANDS PHARMACY GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2019
-----------------------------------------------------
Last Update Date | 12/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 RAYFORD BEND SUITE 200
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77386-4692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-292-2300
-----------------------------------------------------
Fax | 281-367-0605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1230 RAYFORD BEND SUITE 200
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77386-4692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-292-2300
-----------------------------------------------------
Fax | 281-367-0605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | LARRY RICHARDSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-292-2300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------