Provider Demographics
NPI:1336247659
Name:WOLFE, LEAH (RPH)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:WOLFE
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 1:18200 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5605
Mailing Address - Country:US
Mailing Address - Phone:216-476-4338
Mailing Address - Fax:216-476-6953
Practice Address - Street 1:18200 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5605
Practice Address - Country:US
Practice Address - Phone:216-476-4338
Practice Address - Fax:216-476-6953
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-31-0007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist