Provider Demographics
NPI:1063635993
Name:WOOLSEY, ELIZABETH ANN (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WOOLSEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 HOVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:IN
Mailing Address - Zip Code:46360-1521
Mailing Address - Country:US
Mailing Address - Phone:219-879-1640
Mailing Address - Fax:
Practice Address - Street 1:426 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1228
Practice Address - Country:US
Practice Address - Phone:574-234-3184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021547A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist