Provider Demographics
NPI:1982979738
Name:WOLFE, KATHRINE TORRIE (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:TORRIE
Last Name:WOLFE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KATHRINE
Other - Middle Name:TORRIE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3862 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4866
Mailing Address - Country:US
Mailing Address - Phone:503-371-6717
Mailing Address - Fax:
Practice Address - Street 1:3862 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4866
Practice Address - Country:US
Practice Address - Phone:503-371-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5586OtherSTATE PHARMACIST LICENSE