Provider Demographics
NPI:1962800128
Name:WOODLEY, MICHAEL (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WOODLEY
Suffix:
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 1:1110 EDENHURST CT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8484
Mailing Address - Country:US
Mailing Address - Phone:720-838-7905
Mailing Address - Fax:
Practice Address - Street 1:1110 EDENHURST CT
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8484
Practice Address - Country:US
Practice Address - Phone:720-838-7905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO152331835P0018X
TX272971835P0018X
FL471831835P0018X
AK16731835P0018X
TN111731835P0018X
NE122571835P0018X
AR090061835P0018X
MI53020332891835P0018X
SC111561835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist