Provider Demographics
NPI:1861822264
Name:WOLFRAM, CAROLINE A W (RPH)
Entity Type:Individual
Prefix:MS
First Name:CAROLINE
Middle Name:A W
Last Name:WOLFRAM
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 1:717 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4934
Mailing Address - Country:US
Mailing Address - Phone:541-687-5906
Mailing Address - Fax:
Practice Address - Street 1:1590 E 13TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403
Practice Address - Country:US
Practice Address - Phone:541-346-4454
Practice Address - Fax:541-346-2749
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9641183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist