MEDICARE: DIANE WOLFORD PHARMD

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	183500000X	Pharmacist	PCT.0010817	CT

General Provider Information

NPI Number	:	1801176557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE WOLFORD PHARMD

Provider Business Mailing Address
First Line	:	1351 W CAPITOL AVE
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1351 W CAPITOL AVE
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3213
Country	:	US
Telephone Number	:	916-371-3801
Fax Number	:

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

Provider Enumeration Date	:	08/25/2011
Last Update Date	:	08/25/2011

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