Healthcare Provider Details

I. General information

NPI: 1033821095
Provider Name (Legal Business Name): AMY KATHLEEN WOOLLEY-ARDESTANI PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN WOOLLEY PHARMD

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13505 GLEN MILL RD
ROCKVILLE MD
20850-3645
US

IV. Provider business mailing address

740 W PEACHTREE ST NW
ATLANTA GA
30308-1199
US

V. Phone/Fax

Practice location:
  • Phone: 240-277-1192
  • Fax:
Mailing address:
  • Phone: 866-787-6341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19255
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: