Provider Demographics
NPI:1235468422
Name:WOLTER, JENNIFER MOORE (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MOORE
Last Name:WOLTER
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 1:207 HOPESWORTH CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9843
Mailing Address - Country:US
Mailing Address - Phone:919-732-6917
Mailing Address - Fax:
Practice Address - Street 1:123 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-2431
Practice Address - Country:US
Practice Address - Phone:919-563-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12650183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist