Healthcare Provider Details

I. General information

NPI: 1518560242
Provider Name (Legal Business Name): MICHELLE WOLFF RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9086 LONG LAKE PALM DR
BOCA RATON FL
33496-1784
US

IV. Provider business mailing address

9086 LONG LAKE PALM DR
BOCA RATON FL
33496-1784
US

V. Phone/Fax

Practice location:
  • Phone: 561-350-1104
  • Fax:
Mailing address:
  • Phone: 561-350-1104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS30076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: