Healthcare Provider Details

I. General information

NPI: 1144358466
Provider Name (Legal Business Name): JKBC WOLF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W MADISON AVE
ATHENS TN
37303-3433
US

IV. Provider business mailing address

PO BOX 1187
ATHENS TN
37371-1187
US

V. Phone/Fax

Practice location:
  • Phone: 423-746-2626
  • Fax: 423-746-2624
Mailing address:
  • Phone: 423-746-2626
  • Fax: 423-746-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number3583
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JEFFRY H WOLFENDEN
Title or Position: PRESIDENT
Credential: RPH
Phone: 423-746-2626