1194708743 NPI number — B R WOLFE ENTERPRISES INC

Table of content: (NPI 1194708743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194708743 NPI number — B R WOLFE ENTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B R WOLFE ENTERPRISES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CASCADE CLINICAL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194708743
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 238
Provider Second Line Business Mailing Address:
945 W ORCHARD AVE
Provider Business Mailing Address City Name:
HERMISTON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97838-0238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-567-2356
Provider Business Mailing Address Fax Number:
541-564-0378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
945 W ORCHARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMISTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97838-1536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-567-2356
Provider Business Practice Location Address Fax Number:
541-564-0378
Provider Enumeration Date:
11/28/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WOLFE
Authorized Official First Name:
BRAD
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PHARMACIST-IN-CHARGE
Authorized Official Telephone Number:
541-567-2356

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  00235 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009729 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".