Provider Demographics
NPI:1699486324
Name:WOLFE, JASPER DEAN (PHARMD)
Entity type:Individual
Prefix:
First Name:JASPER
Middle Name:DEAN
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 1:3201 DUNWICK DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8439
Mailing Address - Country:US
Mailing Address - Phone:412-977-9598
Mailing Address - Fax:
Practice Address - Street 1:9 CORPORATE PKWY
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7145
Practice Address - Country:US
Practice Address - Phone:843-572-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist