Provider Demographics
NPI:1609478528
Name:WOLFE, AMANDA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
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 1:1482 US HIGHWAY 23 N
Mailing Address - Street 2:
Mailing Address - City:WEBER CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24290-7039
Mailing Address - Country:US
Mailing Address - Phone:276-386-3482
Mailing Address - Fax:276-386-3156
Practice Address - Street 1:1482 US HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:WEBER CITY
Practice Address - State:VA
Practice Address - Zip Code:24290-7039
Practice Address - Country:US
Practice Address - Phone:276-386-3482
Practice Address - Fax:276-386-3156
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202207026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist