Basic Information
| Provider Information | |||||||||
| NPI: | 1487840690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOODY | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | PHARM.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 611 S REGENT ST | ||||||||
| Address2: | |||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952044325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094791857 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1205 E NORTH ST | ||||||||
| Address2: | |||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953364932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092398381 | ||||||||
| FaxNumber: | 2092398334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 09/20/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 59716 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.