Provider Demographics
NPI:1124125968
Name:WOLFES PHARMACY INC
Entity type:Organization
Organization Name:WOLFES PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-594-5821
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:CHAUVIN
Mailing Address - State:LA
Mailing Address - Zip Code:70344-0597
Mailing Address - Country:US
Mailing Address - Phone:985-594-5821
Mailing Address - Fax:985-594-3280
Practice Address - Street 1:5458 HIGHWAY 56
Practice Address - Street 2:
Practice Address - City:CHAUVIN
Practice Address - State:LA
Practice Address - Zip Code:70344-3102
Practice Address - Country:US
Practice Address - Phone:985-594-5821
Practice Address - Fax:985-594-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
LAPHY.001217-IR3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2029681OtherPK
LA1243591Medicaid
2029681OtherPK