Organization
WOODBINE MEDICAL, LLC
Active
Other names
Woodbine Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN CLEMENTS PHARM.D. (MEMBER / CEO)
(912) 464-7186
Entity
Organization
Contact information
Practice address
908 GEORGIA AVE, SUITE 1, WOODBINE, GA 31569-3574
(912) 576-6998
(912) 729-7275
Mailing address
PO BOX 729, WOODBINE, GA 31569-0729
(912) 576-6998
(912) 729-7275
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE008800
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000032568C
—
GA
01
—
2126185
PK
—
Enumeration date
08/10/2006
Last updated
09/23/2021
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