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General NPI Number Information
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NPI Number | 1811523657
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Entity Type | Organization
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Legal Business Name | DOGWOOD PHARMACY LLC
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 205 S MAGNOLIA ST
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City | WOODVILLE
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State | TX
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Zip | 75979-5234
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Country | US
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Telephone | 409-283-7509
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Fax | 409-283-7395
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Provider Business Mailing Address
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Address Line | 205 S MAGNOLIA ST
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City | WOODVILLE
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State | TX
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Zip | 75979-5234
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Country | US
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Telephone | 409-283-7509
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Fax | 409-283-7395
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Authorized Official
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Title or Position | SOLE OWNER
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Name | JEFFREY SCOTT TERRY
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Credential | RPH
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Telephone | 409-283-7509
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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 |
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License Number State |
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