Provider Demographics
NPI:1245604115
Name:WOLFE, LAURA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BEECHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROARING BROOK TWP
Mailing Address - State:PA
Mailing Address - Zip Code:18444-7607
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1025 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1713
Practice Address - Country:US
Practice Address - Phone:570-905-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449714183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist