Provider Demographics
NPI:1215575410
Name:WOLFE, ERIC (PHARMD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 SNAKE FOOT DRIVE
Mailing Address - Street 2:APT 204
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243
Mailing Address - Country:US
Mailing Address - Phone:570-428-5463
Mailing Address - Fax:
Practice Address - Street 1:1320 SNAKE FOOT DRIVE
Practice Address - Street 2:APT 204
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243
Practice Address - Country:US
Practice Address - Phone:570-428-5463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027764A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist