Basic Information
| Provider Information | |||||||||
| NPI: | 1427505452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODWARD | ||||||||
| FirstName: | COREY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2712 LAWRENCEVILLE HWY | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300332512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704965555 | ||||||||
| FaxNumber: | 7709392887 | ||||||||
| Practice Location | |||||||||
| Address1: | 2712 LAWRENCEVILLE HWY | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300332512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704965555 | ||||||||
| FaxNumber: | 7709392887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2016 | ||||||||
| LastUpdateDate: | 09/07/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1835X0200X | RPH027456 | GA | Y | Pharmacy Service Providers | Pharmacist | Oncology |
No ID Information.