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NPI Code Detail

MEDICARE: MR. CRAIG WOLF

MEDICARE: MR. CRAIG WOLF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051.286312IL

General Provider Information

NPI Number : 1508147620
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CRAIG WOLF
Provider Business Mailing Address
First Line : 3040 W JEROME ST
Second Line :
City : CHICAGO
State : IL
Zip : 60645-1141
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8361 BELMONT AVE
Second Line :
City : RIVER GROVE
State : IL
Zip : 60171-1001
Country : US
Telephone Number : 708-452-8062
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2011
Last Update Date : 09/01/2011

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Directions to “ MR. CRAIG WOLF ” Practice Location

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