MEDICARE: WOODY'S PHARMACY, INC.

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	PHRE008579	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326104555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODY'S PHARMACY, INC.

Provider Business Mailing Address
First Line	:	5226 DAHLONEGA HWY
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-1900
Country	:	US
Telephone Number	:	770-983-3510
Fax Number	:	770-983-7986

Provider Business Practice Location Address
First Line	:	5226 DAHLONEGA HWY
Second Line	:
City	:	CLERMONT
State	:	GA
Zip	:	30527-1900
Country	:	US
Telephone Number	:	770-983-3510
Fax Number	:	770-983-7986

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KEVIN JOSEPH WOODY
Credential	:	RPH.
Telephone Number	:	770-983-3510

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	08/22/2020

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