Provider Demographics
NPI:1861495673
Name:WOLFGRAM, PETER D (RPH)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:D
Last Name:WOLFGRAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 SHEEPSHANK DR
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-8801
Mailing Address - Country:US
Mailing Address - Phone:406-388-0333
Mailing Address - Fax:
Practice Address - Street 1:327 S EXCELSIOR AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1536
Practice Address - Country:US
Practice Address - Phone:406-723-3308
Practice Address - Fax:406-782-8243
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist