Provider Demographics
NPI:1275201568
Name:WOLFE, MOLLIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E MATTHEWS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4344
Mailing Address - Country:US
Mailing Address - Phone:870-972-6470
Mailing Address - Fax:
Practice Address - Street 1:1000 E MATTHEWS AVE STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4344
Practice Address - Country:US
Practice Address - Phone:870-972-6470
Practice Address - Fax:870-972-0710
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD15763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist