Provider Demographics
NPI:1497350953
Name:WOLFF, FRED MARTIN
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:MARTIN
Last Name:WOLFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1148
Mailing Address - Country:US
Mailing Address - Phone:847-885-1326
Mailing Address - Fax:847-885-4271
Practice Address - Street 1:1801 W GOLF RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-1148
Practice Address - Country:US
Practice Address - Phone:847-885-1326
Practice Address - Fax:847-885-4271
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051031472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist