Provider Demographics
NPI:1134277130
Name:F H WOLKEN INC
Entity type:Organization
Organization Name:F H WOLKEN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER,PRESIDENT,AO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLKEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:330-332-9919
Mailing Address - Street 1:1136 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-2230
Mailing Address - Country:US
Mailing Address - Phone:330-332-9919
Mailing Address - Fax:330-332-2501
Practice Address - Street 1:1136 E STATE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2230
Practice Address - Country:US
Practice Address - Phone:330-332-9919
Practice Address - Fax:330-332-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 332B00000X
OH0205119503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0672759Medicaid
2077097OtherPK
1151560002Medicare NSC