MEDICARE: MR. PETER D WOLFGRAM RPH

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
1	183500000X	Pharmacist	2422	MT

General Provider Information

NPI Number	:	1861495673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PETER D WOLFGRAM RPH

Provider Business Mailing Address
First Line	:	2701 SHEEPSHANK DR
Second Line	:
City	:	BELGRADE
State	:	MT
Zip	:	59714-8801
Country	:	US
Telephone Number	:	406-388-0333
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 S EXCELSIOR AVE
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-1536
Country	:	US
Telephone Number	:	406-723-3308
Fax Number	:	406-782-8243

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/08/2011

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