Provider Demographics
NPI:1639599905
Name:WOOLSEY, ROBERT II
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WOOLSEY
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3436 PHILPOT RD
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-9816
Mailing Address - Country:US
Mailing Address - Phone:479-667-4145
Mailing Address - Fax:479-667-4879
Practice Address - Street 1:810 W COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-3010
Practice Address - Country:US
Practice Address - Phone:479-667-4145
Practice Address - Fax:479-667-4879
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-24
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR8203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR100582407Medicaid
AR100582407Medicaid