Provider Demographics
NPI:1447468889
Name:WOLFORD, JARRYL M (RPH)
Entity type:Individual
Prefix:
First Name:JARRYL
Middle Name:M
Last Name:WOLFORD
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21531-0127
Mailing Address - Country:US
Mailing Address - Phone:301-746-5881
Mailing Address - Fax:
Practice Address - Street 1:504 POCAHONTAS ST
Practice Address - Street 2:
Practice Address - City:MT LAKE PARK
Practice Address - State:MD
Practice Address - Zip Code:21550-2804
Practice Address - Country:US
Practice Address - Phone:301-334-9521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD006773183500000X
PA025722183500000X
WV002576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist