Provider Demographics
NPI:1629658257
Name:WOLFE, CAROLYN (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
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 1:19040 E VALLEY VIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7004
Mailing Address - Country:US
Mailing Address - Phone:816-200-2002
Mailing Address - Fax:
Practice Address - Street 1:19040 E VALLEY VIEW PKWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7004
Practice Address - Country:US
Practice Address - Phone:816-200-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-106195183500000X
MO2018039414183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist