Provider Demographics
NPI:1487492161
Name:JKBC WOLF INC
Entity type:Organization
Organization Name:JKBC WOLF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFENDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:423-746-2626
Mailing Address - Street 1:PO BOX 1187
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37371-1187
Mailing Address - Country:US
Mailing Address - Phone:423-746-2626
Mailing Address - Fax:423-746-2624
Practice Address - Street 1:1001 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3433
Practice Address - Country:US
Practice Address - Phone:423-746-2626
Practice Address - Fax:423-746-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy