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NPI Code Detail

MEDICARE: ROY EDWARD WOLF DPH

MEDICARE: ROY EDWARD WOLF DPH
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
1183500000XPharmacist10283TN

General Provider Information

NPI Number : 1770895880
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY EDWARD WOLF DPH
Provider Business Mailing Address
First Line : 4122 QUARRY VW
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37415-2097
Country : US
Telephone Number : 423-877-7427
Fax Number :
Provider Business Practice Location Address
First Line : 4039 DAYTON BLVD
Second Line :
City : RED BANK
State : TN
Zip : 37415-7124
Country : US
Telephone Number : 423-870-0859
Fax Number : 423-870-8724
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2010
Last Update Date : 07/06/2010

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Directions to “ ROY EDWARD WOLF DPH” Practice Location

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