Provider Demographics
NPI:1891183083
Name:WOLF, MARC (RPH)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:WOLF
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 1:110 N STRAWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MORELAND HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1269
Mailing Address - Country:US
Mailing Address - Phone:216-570-3691
Mailing Address - Fax:
Practice Address - Street 1:1409 GOLDEN GATE BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124-1808
Practice Address - Country:US
Practice Address - Phone:440-544-1352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-23
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03314380183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist