Provider Demographics
NPI:1366593139
Name:WOODSTOCK DRUG INC
Entity type:Organization
Organization Name:WOODSTOCK DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROOKER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-938-9221
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:28891 HIGHWAY 5
Mailing Address - City:WOODSTOCK
Mailing Address - State:AL
Mailing Address - Zip Code:35188-0280
Mailing Address - Country:US
Mailing Address - Phone:205-938-9221
Mailing Address - Fax:205-938-9290
Practice Address - Street 1:28891 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:AL
Practice Address - Zip Code:35188-0280
Practice Address - Country:US
Practice Address - Phone:205-938-9221
Practice Address - Fax:205-938-9290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1102453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002314Medicaid
AL6459960001Medicare NSC