Provider Demographics
NPI:1699331181
Name:WOOLLEY, JENNIFER D (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:WOOLLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 E HWY 50
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-2788
Mailing Address - Country:US
Mailing Address - Phone:719-275-1641
Mailing Address - Fax:719-275-1643
Practice Address - Street 1:3105 E HWY 50
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2797
Practice Address - Country:US
Practice Address - Phone:719-275-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20181OtherCOLORADO PHARMACY BOARD