MEDICARE: ANGEL WOLF PHARM.D., BCPP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1300X	Psychiatric Pharmacist	PS40665	FL

General Provider Information

NPI Number	:	1285817304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL WOLF PHARM.D., BCPP

Provider Business Mailing Address
First Line	:	8735 HENDERSON RD
Second Line	:	REN 4, FLOOR 2
City	:	TAMPA
State	:	FL
Zip	:	33634-1143
Country	:	US
Telephone Number	:	813-290-6200
Fax Number	:	813-464-8818

Provider Business Practice Location Address
First Line	:	8735 HENDERSON RD
Second Line	:	REN 4, FLOOR 2
City	:	TAMPA
State	:	FL
Zip	:	33634-1143
Country	:	US
Telephone Number	:	813-290-6200
Fax Number	:	813-464-8818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	02/01/2010

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