MEDICARE: DAVID ALLEN WOODWORTH R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS33297	FL
2	183500000X	Pharmacist	PH00009504	WA

General Provider Information

NPI Number	:	1093985053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALLEN WOODWORTH R.PH.

Provider Business Mailing Address
First Line	:	2160 PARK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3812
Country	:	US
Telephone Number	:	904-389-9744
Fax Number	:	904-389-9406

Provider Business Practice Location Address
First Line	:	2160 PARK ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-3812
Country	:	US
Telephone Number	:	904-389-9744
Fax Number	:	904-389-9406

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	03/06/2008

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