Provider Demographics
NPI:1285012419
Name:WOOLLEY, MARTINE
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:
Last Name:WOOLLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11270 MUSETTE CIR
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-8699
Mailing Address - Country:US
Mailing Address - Phone:954-290-1215
Mailing Address - Fax:
Practice Address - Street 1:11270 MUSETTE CIR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-8699
Practice Address - Country:US
Practice Address - Phone:954-290-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist