Basic Information
| Provider Information | |||||||||
| NPI: | 1730510231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLFE | ||||||||
| FirstName: | PHYLLIS | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | RPH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 122 | ||||||||
| Address2: | |||||||||
| City: | CORDOVA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290390122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035360842 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3310 MAGNOLIA ST | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291151466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035316940 | ||||||||
| FaxNumber: | 8035318988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2013 | ||||||||
| LastUpdateDate: | 01/31/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 005593 | SC | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.