=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245395672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOODLAWN PHARMACEUTICAL GROUP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 03/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2215 ROLLINGBROOK DRIVE STE 120A
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-928-3044
-----------------------------------------------------
Fax | 713-947-8081
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2215 ROLLINGBROOK DRIVE STE 120A
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-928-3044
-----------------------------------------------------
Fax | 713-947-8081
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER & P.I.C.
-----------------------------------------------------
Name | MR. MOSUDI MUHAMMED ADEGBINDIN
-----------------------------------------------------
Credential | PHARM. D.
-----------------------------------------------------
Telephone | 713-928-3044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 22421
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------