Healthcare Provider Details

I. General information

NPI: 1134277130
Provider Name (Legal Business Name): F H WOLKEN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 E STATE ST
SALEM OH
44460-2230
US

IV. Provider business mailing address

1136 E STATE ST
SALEM OH
44460-2230
US

V. Phone/Fax

Practice location:
  • Phone: 330-332-9919
  • Fax: 330-332-2501
Mailing address:
  • Phone: 330-332-9919
  • Fax: 330-332-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number020511950
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK WOLKEN
Title or Position: OWNER,PRESIDENT,AO
Credential: RPH
Phone: 330-332-9919