Healthcare Provider Details

I. General information

NPI: 1427952332
Provider Name (Legal Business Name): JOHANNA WOLFE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 SW MADISON ST
PORTLAND OR
97205-1715
US

IV. Provider business mailing address

18540 SW BOONES FERRY RD APT B8
TUALATIN OR
97062-9432
US

V. Phone/Fax

Practice location:
  • Phone: 503-224-1044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT-0032584
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: