Basic Information
| Provider Information | |||||||||
| NPI: | 1609476092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOFFORD | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ANDREW | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1823 HUNTERS PL | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729215120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796510572 | ||||||||
| FaxNumber: | 4796324509 | ||||||||
| Practice Location | |||||||||
| Address1: | 367 W CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | ALMA | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729213408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796324330 | ||||||||
| FaxNumber: | 4796324509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2020 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PD07819 | AR | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.