Provider Demographics
NPI:1962876771
Name:WOOLDRIDGE, KELLY (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:WOOLDRIDGE
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 1:2001 CAMPBELL STATION PKWY
Mailing Address - Street 2:SUITE A-5
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-7417
Mailing Address - Country:US
Mailing Address - Phone:855-273-3924
Mailing Address - Fax:
Practice Address - Street 1:2001 CAMPBELL STATION PKWY
Practice Address - Street 2:SUITE A-5
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-7417
Practice Address - Country:US
Practice Address - Phone:855-273-3924
Practice Address - Fax:855-273-3925
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
244183OtherNABP