Provider Demographics
NPI:1285797407
Name:LES & MAXINE WOLFF INC
Entity type:Organization
Organization Name:LES & MAXINE WOLFF INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELMER
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:320-632-6645
Mailing Address - Street 1:101 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3001
Mailing Address - Country:US
Mailing Address - Phone:320-632-6645
Mailing Address - Fax:320-632-6273
Practice Address - Street 1:101 1ST ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3001
Practice Address - Country:US
Practice Address - Phone:320-632-6645
Practice Address - Fax:320-632-6273
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LES & MAXINE WOLFF INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-19
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2621461333600000X
MN262146333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2424808OtherNABP
MN366098200Medicaid
MN0174490002Medicare NSC