Provider Demographics
NPI:1134499643
Name:DEWOLFE, KATHRYN CLARE (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CLARE
Last Name:DEWOLFE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2662 148TH ST W
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-3185
Mailing Address - Country:US
Mailing Address - Phone:612-310-6066
Mailing Address - Fax:
Practice Address - Street 1:2662 148TH ST W
Practice Address - Street 2:
Practice Address - City:ROSEMOUNT
Practice Address - State:MN
Practice Address - Zip Code:55068-3185
Practice Address - Country:US
Practice Address - Phone:612-310-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2012-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist