Provider Demographics
NPI:1841894037
Name:WOLF, DAVID ALLAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALLAN
Last Name:WOLF
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 1:350 BUCK RD
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-3309
Mailing Address - Country:US
Mailing Address - Phone:856-307-0060
Mailing Address - Fax:
Practice Address - Street 1:350 BUCK RD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-3309
Practice Address - Country:US
Practice Address - Phone:856-307-0060
Practice Address - Fax:856-307-0037
Is Sole Proprietor?:No
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02560600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist