Provider Demographics
NPI:1265728257
Name:WOODARD, ANGELA (RPHT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:WOODARD
Suffix:
Gender:F
Credentials:RPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4935 COCOANUT DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-6910
Mailing Address - Country:US
Mailing Address - Phone:561-632-6246
Mailing Address - Fax:
Practice Address - Street 1:96 SW ALLAPATTAH RD
Practice Address - Street 2:
Practice Address - City:INDIANTOWN
Practice Address - State:FL
Practice Address - Zip Code:34956-4307
Practice Address - Country:US
Practice Address - Phone:772-597-9468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT 2281183700000X
FL1801-0272-3722-941183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician