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NPI Code Detail

MEDICARE: DR. JILLIAN WOLFRUM PHARM. D

MEDICARE: DR. JILLIAN WOLFRUM PHARM. D
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
1183500000XPharmacist45947TX

General Provider Information

NPI Number : 1932436383
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JILLIAN WOLFRUM PHARM. D
Provider Business Mailing Address
First Line : 9902 WOOD FOREST DR
Second Line :
City : DALLAS
State : TX
Zip : 75243-4920
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5742 E MOCKINGBIRD LN
Second Line :
City : DALLAS
State : TX
Zip : 75206-5422
Country : US
Telephone Number : 214-826-7136
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2009
Last Update Date : 11/05/2009

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