Provider Demographics
NPI:1982926762
Name:WOO, CAROLYN V (RPH)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:V
Last Name:WOO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 IRWIN AVE NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4435
Mailing Address - Country:US
Mailing Address - Phone:850-244-7143
Mailing Address - Fax:850-243-8517
Practice Address - Street 1:200 IRWIN AVE NE
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4435
Practice Address - Country:US
Practice Address - Phone:850-244-7143
Practice Address - Fax:850-243-8517
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist