Provider Demographics
NPI:1235732934
Name:WOLF, TRAVER (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:TRAVER
Middle Name:
Last Name:WOLF
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JASONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47438-1510
Mailing Address - Country:US
Mailing Address - Phone:812-665-9760
Mailing Address - Fax:812-665-9762
Practice Address - Street 1:346 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JASONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47438-1510
Practice Address - Country:US
Practice Address - Phone:812-665-9760
Practice Address - Fax:812-665-9762
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020204A1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist