Provider Demographics
NPI:1184930877
Name:WOLF, BRIANNE LEIGH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:LEIGH
Last Name:WOLF
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 1:1115 W PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6520
Mailing Address - Country:US
Mailing Address - Phone:440-998-3777
Mailing Address - Fax:
Practice Address - Street 1:1115 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6520
Practice Address - Country:US
Practice Address - Phone:440-998-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444808183500000X
OHRPH.03230146-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist