Provider Demographics
NPI:1285762435
Name:WOOLERY, ROY C III (RPH)
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:C
Last Name:WOOLERY
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21550 HALL RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5200
Mailing Address - Country:US
Mailing Address - Phone:734-676-2437
Mailing Address - Fax:
Practice Address - Street 1:37340 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1800
Practice Address - Country:US
Practice Address - Phone:734-953-2727
Practice Address - Fax:734-953-8555
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2015-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302021787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist