Provider Demographics
NPI:1750650396
Name:WOLF, KRISTA MICHELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:MICHELLE
Last Name:WOLF
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:MICHELLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1011 E 2ND AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2207
Mailing Address - Country:US
Mailing Address - Phone:509-744-9891
Mailing Address - Fax:509-742-3494
Practice Address - Street 1:1011 E 2ND AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2207
Practice Address - Country:US
Practice Address - Phone:509-744-9891
Practice Address - Fax:509-742-3494
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60219644183500000X
IL051.294178183500000X
CO19294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist