Provider Demographics
NPI:1033821095
Name:WOOLLEY-ARDESTANI, AMY KATHLEEN (PHARMD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:KATHLEEN
Last Name:WOOLLEY-ARDESTANI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:WOOLLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:740 W PEACHTREE ST NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1199
Mailing Address - Country:US
Mailing Address - Phone:866-787-6341
Mailing Address - Fax:
Practice Address - Street 1:13505 GLEN MILL RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3645
Practice Address - Country:US
Practice Address - Phone:240-277-1192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-21
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19255183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist