Organization
JKBC WOLF INC
Active
Other names
MADISON AVENUE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFRY H WOLFENDEN RPH (PRESIDENT)
(423) 746-2626
Entity
Organization
Contact information
Practice address
1001 W MADISON AVE, ATHENS, TN 37303-3433
(423) 746-2626
(423) 746-2624
Mailing address
PO BOX 1187, ATHENS, TN 37371-1187
(423) 746-2626
(423) 746-2624
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
3583
TN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1452528
—
TN
01
—
4434584
NCPDP
TN
Enumeration date
02/28/2007
Last updated
03/07/2023
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