Healthcare Provider Details

I. General information

NPI: 1609478528
Provider Name (Legal Business Name): AMANDA WOLFE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1482 US HIGHWAY 23 N
WEBER CITY VA
24290-7039
US

IV. Provider business mailing address

1482 US HIGHWAY 23 N
WEBER CITY VA
24290-7039
US

V. Phone/Fax

Practice location:
  • Phone: 276-386-3482
  • Fax: 276-386-3156
Mailing address:
  • Phone: 276-386-3482
  • Fax: 276-386-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202207026
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: