=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558345603
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL SAMUEL WOLF PHARM.D., PH.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 COMMERCE ST. WALD DRUGS
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-782-2224
-----------------------------------------------------
Fax | 908-806-6793
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 269 OLD YORK RD
-----------------------------------------------------
City | FLEMINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08822-1924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-788-3635
-----------------------------------------------------
Fax | 908-788-9472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI01557700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RP029223L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------