MEDICARE: DR. ANQUINTARR E WOODRUFF PHARM D

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	023378	GA

General Provider Information

NPI Number	:	1538552997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANQUINTARR E WOODRUFF PHARM D

Provider Business Mailing Address
First Line	:	1610 WINDY RIDGE LN SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2448
Country	:	US
Telephone Number	:	404-425-0211
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 WINDY RIDGE LN SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-2448
Country	:	US
Telephone Number	:	404-425-0211
Fax Number	:

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

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	03/10/2015

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