=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669643946
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT LEE WOOLFOLK RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2008
-----------------------------------------------------
Last Update Date | 03/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5171 SAM JARED DR
-----------------------------------------------------
City | MURFREESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37130-1382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-867-5912
-----------------------------------------------------
Fax | 615-867-5759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5171 SAM JARED DR
-----------------------------------------------------
City | MURFREESBORO
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37130-1382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-867-5912
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | E6216
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------