Provider Demographics
NPI:1730178526
Name:WOODROW PHARMACY LTD
Entity type:Organization
Organization Name:WOODROW PHARMACY LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-967-2955
Mailing Address - Street 1:645 ROSSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1752
Mailing Address - Country:US
Mailing Address - Phone:718-967-2955
Mailing Address - Fax:718-967-2978
Practice Address - Street 1:645 ROSSVILLE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1752
Practice Address - Country:US
Practice Address - Phone:718-967-2955
Practice Address - Fax:718-967-2978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0215003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01496400Medicaid
3327245OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5288470001Medicare NSC