Provider Demographics
NPI:1093372856
Name:WOOLSON, RUTH ANN
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ANN
Last Name:WOOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IL
Mailing Address - Zip Code:62379-1533
Mailing Address - Country:US
Mailing Address - Phone:217-242-8960
Mailing Address - Fax:
Practice Address - Street 1:300 N PARK DR
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-2200
Practice Address - Country:US
Practice Address - Phone:319-524-4071
Practice Address - Fax:319-524-4073
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20021183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty