Provider Demographics
NPI:1285981795
Name:WOLFE, GARY WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:WAYNE
Last Name:WOLFE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 EL PASEO RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6000
Mailing Address - Country:US
Mailing Address - Phone:575-541-1264
Mailing Address - Fax:575-541-1292
Practice Address - Street 1:1285 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6000
Practice Address - Country:US
Practice Address - Phone:575-541-1264
Practice Address - Fax:575-541-1292
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007287183500000X
GARPH021534183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist