Provider Demographics
NPI:1619515228
Name:WOLFE, JEREMY (PHARM D)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:WOLFE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14000 CANTRELL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-1517
Mailing Address - Country:US
Mailing Address - Phone:501-225-6006
Mailing Address - Fax:501-225-3926
Practice Address - Street 1:14000 CANTRELL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-1517
Practice Address - Country:US
Practice Address - Phone:501-225-6006
Practice Address - Fax:501-225-3926
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD09901183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist