Provider Demographics
NPI:1609162569
Name:WULF, RICHARD ANDREW (PHARMBS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ANDREW
Last Name:WULF
Suffix:
Gender:M
Credentials:PHARMBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 GENERAL STILWELL DR
Mailing Address - Street 2:T-2306
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-6242
Mailing Address - Country:US
Mailing Address - Phone:831-883-5721
Mailing Address - Fax:831-883-5721
Practice Address - Street 1:133 GENERAL STILWELL DR
Practice Address - Street 2:T-2306
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-6242
Practice Address - Country:US
Practice Address - Phone:831-883-5721
Practice Address - Fax:831-883-5721
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32955183500000X
CA032955183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist