Provider Demographics
NPI:1346461811
Name:WOOLARD, DOUG ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUG
Middle Name:ALAN
Last Name:WOOLARD
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 1:16216 HARRIS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62951-2809
Mailing Address - Country:US
Mailing Address - Phone:618-922-3454
Mailing Address - Fax:
Practice Address - Street 1:7846 AVIATION DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5818
Practice Address - Country:US
Practice Address - Phone:618-993-2900
Practice Address - Fax:618-998-1485
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric