Provider Demographics
NPI:1417524174
Name:WOLVERTON, DYLAN (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
Last Name:WOLVERTON
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 LEAF LN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-1782
Mailing Address - Country:US
Mailing Address - Phone:732-575-9259
Mailing Address - Fax:
Practice Address - Street 1:2479 CHURCH RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8109
Practice Address - Country:US
Practice Address - Phone:732-920-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04172400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist