Healthcare Provider Details

I. General information

NPI: 1114422698
Provider Name (Legal Business Name): STEVEN WULFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BOX OAK
SHAVANO PARK TX
78230-5630
US

IV. Provider business mailing address

207 BOX OAK
SHAVANO PARK TX
78230-5630
US

V. Phone/Fax

Practice location:
  • Phone: 210-334-5318
  • Fax:
Mailing address:
  • Phone: 210-334-5318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35636
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: