Provider Demographics
NPI:1184229155
Name:WOOLDRIDGE, ROBERT BRYAN (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRYAN
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 1:9170 NEW HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:TELLICO PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37385-5397
Mailing Address - Country:US
Mailing Address - Phone:423-253-2823
Mailing Address - Fax:423-253-3247
Practice Address - Street 1:9170 NEW HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:TELLICO PLAINS
Practice Address - State:TN
Practice Address - Zip Code:37385-5397
Practice Address - Country:US
Practice Address - Phone:423-253-2823
Practice Address - Fax:423-253-3247
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7133183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist