Provider Demographics
NPI:1184857484
Name:WOLKOWICZ, WAYNE JOSEPH (DPH)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:JOSEPH
Last Name:WOLKOWICZ
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 EAST DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4531
Mailing Address - Country:US
Mailing Address - Phone:615-868-0792
Mailing Address - Fax:615-860-4541
Practice Address - Street 1:3443 DICKERSON PIKE
Practice Address - Street 2:SUITE 110
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2519
Practice Address - Country:US
Practice Address - Phone:615-868-0792
Practice Address - Fax:615-860-4541
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11544183500000X
KY011453183500000X
IL051-040812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist