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General NPI Number Information
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NPI Number | 1861495673
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Entity Type | Individual
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Provider Name | PETER D WOLFGRAM RPH
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 01/08/2011
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Provider Practice Location Address
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Address Line | 327 S EXCELSIOR AVE
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City | BUTTE
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State | MT
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Zip | 59701-1536
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Country | US
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Telephone | 406-723-3308
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Fax | 406-782-8243
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Provider Business Mailing Address
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Address Line | 2701 SHEEPSHANK DR
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City | BELGRADE
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State | MT
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Zip | 59714-8801
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Country | US
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Telephone | 406-388-0333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2422
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License Number State | MT
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