Healthcare Provider Details

I. General information

NPI: 1710077862
Provider Name (Legal Business Name): CAROLYN MELISSA WOODLEY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467-2401
US

IV. Provider business mailing address

1251 HARROD AVE
BRONX NY
10472-2703
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-8354
  • Fax:
Mailing address:
  • Phone: 718-701-2358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0486281
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1835N0905X
TaxonomyNuclear Pharmacist
License Number0486281
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: