Provider Demographics
NPI:1538467626
Name:ZOLDOS, ROY WILLIAM
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:WILLIAM
Last Name:ZOLDOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:759 EASTHILL DR NE
Mailing Address - Street 2:
Mailing Address - City:COMSTOCK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:49321-9509
Mailing Address - Country:US
Mailing Address - Phone:616-784-4972
Mailing Address - Fax:
Practice Address - Street 1:11 E DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-1325
Practice Address - Country:US
Practice Address - Phone:616-887-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302023400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist