Provider Demographics
NPI:1023544889
Name:WOLF, ANDREA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:WOLF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2437 TAYLOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8036
Mailing Address - Country:US
Mailing Address - Phone:614-655-5002
Mailing Address - Fax:
Practice Address - Street 1:2437 TAYLOR PARK DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8036
Practice Address - Country:US
Practice Address - Phone:614-655-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03131905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist