Provider Demographics
NPI:1154084234
Name:WOLF, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 STATION ST
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-1165
Mailing Address - Country:US
Mailing Address - Phone:724-926-2201
Mailing Address - Fax:
Practice Address - Street 1:200 STATION ST
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:PA
Practice Address - Zip Code:15057-1165
Practice Address - Country:US
Practice Address - Phone:724-926-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP441998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist