Provider Demographics
NPI:1508207556
Name:WOLF, JORDAN ALEXANDER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ALEXANDER
Last Name:WOLF
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6055 NATHAN LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1674
Mailing Address - Country:US
Mailing Address - Phone:612-849-2995
Mailing Address - Fax:763-248-7593
Practice Address - Street 1:6055 NATHAN LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1674
Practice Address - Country:US
Practice Address - Phone:612-849-2995
Practice Address - Fax:763-248-7593
Is Sole Proprietor?:No
Enumeration Date:2013-07-07
Last Update Date:2013-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120946183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist