Provider Demographics
NPI:1033122452
Name:WOHLEB, JEROME WAYNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:WAYNE
Last Name:WOHLEB
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 1:1738 KUDU CT
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9375
Mailing Address - Country:US
Mailing Address - Phone:801-553-2635
Mailing Address - Fax:
Practice Address - Street 1:1738 KUDU CT
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9375
Practice Address - Country:US
Practice Address - Phone:801-553-2635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6038323-1701183500000X, 1835P1200X
AZ76481835P1200X
NE91811835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Multi-Specialty