Provider Demographics
NPI:1235280942
Name:WOOLDRIDGE, WESLEY CECIL (RPH)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:CECIL
Last Name:WOOLDRIDGE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 BAHIA DEL SOL DR APT B
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3076
Mailing Address - Country:US
Mailing Address - Phone:813-641-9552
Mailing Address - Fax:
Practice Address - Street 1:817 BAHIA DEL SOL DR APT B
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3076
Practice Address - Country:US
Practice Address - Phone:813-641-9552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9533183500000X
FLPS21928183500000X
GARPH011678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist