Provider Demographics
NPI:1679875199
Name:WOLFF, GINA L (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:L
Last Name:WOLFF
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:RR 1 BOX 59
Mailing Address - Street 2:
Mailing Address - City:SAINT ELMO
Mailing Address - State:IL
Mailing Address - Zip Code:62458-9720
Mailing Address - Country:US
Mailing Address - Phone:618-349-0938
Mailing Address - Fax:
Practice Address - Street 1:1006 N KELLER DR
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-1743
Practice Address - Country:US
Practice Address - Phone:217-347-2560
Practice Address - Fax:217-347-3877
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2010-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291685183500000X
IN26021510A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist