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General NPI Number Information
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NPI Number | 1629089289
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Entity Type | Organization
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Legal Business Name | WOODMARK PHARMACY
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Dates
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Enumeration Date | 08/10/2006
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 1142 WEHRLE DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-7748
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Country | US
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Telephone | 716-631-3381
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Fax | 716-631-3097
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Provider Business Mailing Address
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Address Line | 1142 WEHRLE DR
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-7748
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Country | US
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Telephone | 716-631-3381
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Fax | 716-631-3097
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Authorized Official
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Title or Position | SUPERVISING PHARMACIST
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Name | STACY JOHNSON
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Credential |
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Telephone | 716-631-3381
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 031869
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License Number State | NY
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