Provider Demographics
NPI:1992467906
Name:WOLF, THOMAS I (PHARMD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:I
Last Name:WOLF
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 1:3055 FLOYD AVE APT E366
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7938
Mailing Address - Country:US
Mailing Address - Phone:916-764-5730
Mailing Address - Fax:
Practice Address - Street 1:1101 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5439
Practice Address - Country:US
Practice Address - Phone:209-577-8695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82266183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist