Provider Demographics
NPI:1699045195
Name:WOLFE, JENNIFER BERRY (RPH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BERRY
Last Name:WOLFE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9109 PINE SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8095
Mailing Address - Country:US
Mailing Address - Phone:704-875-3424
Mailing Address - Fax:
Practice Address - Street 1:16711 BIRKDALE COMMONS PKWY
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-4412
Practice Address - Country:US
Practice Address - Phone:704-894-9781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist