Provider Demographics
NPI:1174908693
Name:WOODROME, MARTIN SHEA
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:SHEA
Last Name:WOODROME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 MACGREGOR PL
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9688
Mailing Address - Country:US
Mailing Address - Phone:812-989-4053
Mailing Address - Fax:
Practice Address - Street 1:9801 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-1125
Practice Address - Country:US
Practice Address - Phone:502-327-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY017944183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist