Provider Demographics
NPI:1679193171
Name:WOLFF, AUTUMN NICHOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:NICHOLE
Last Name:WOLFF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:NICHOLE
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:324 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401
Mailing Address - Country:US
Mailing Address - Phone:406-453-1497
Mailing Address - Fax:
Practice Address - Street 1:324 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-453-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-24
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-6491183500000X
CA59849183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist