Provider Demographics
NPI:1770102246
Name:WOLFE, WENDY SUE
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 4TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-4664
Mailing Address - Country:US
Mailing Address - Phone:641-424-1343
Mailing Address - Fax:641-424-0105
Practice Address - Street 1:2400 4TH ST SW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-4664
Practice Address - Country:US
Practice Address - Phone:641-424-1343
Practice Address - Fax:641-424-0105
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18362333600000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy