Provider Demographics
NPI:1386936045
Name:WOLKE, ROBBIE J (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBBIE
Middle Name:J
Last Name:WOLKE
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 1:915 W CHAMBERS ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-2311
Mailing Address - Country:US
Mailing Address - Phone:217-553-5382
Mailing Address - Fax:
Practice Address - Street 1:1911 E SANGAMON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-1206
Practice Address - Country:US
Practice Address - Phone:217-744-1960
Practice Address - Fax:217-744-2526
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.288675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist