=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386936045
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBBIE J WOLKE R.P.H.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2011
-----------------------------------------------------
Last Update Date | 05/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1911 E SANGAMON AVE
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62702-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-744-1960
-----------------------------------------------------
Fax | 217-744-2526
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 915 W CHAMBERS ST
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62650-2311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-553-5382
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 051.288675
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------