Provider Demographics
NPI:1720410624
Name:WOLFE, BRIANNE MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:MARIE
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 1:2641 E STRINGHAM AVE APT 301C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-3984
Mailing Address - Country:US
Mailing Address - Phone:406-390-0948
Mailing Address - Fax:
Practice Address - Street 1:2641 E STRINGHAM AVE APT 301C
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-3984
Practice Address - Country:US
Practice Address - Phone:406-390-0948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8685889-17011835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist