MEDICARE: WELLTECH NETWORK INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	PHY42003	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0568937	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1053450908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLTECH NETWORK INC

Provider Business Mailing Address
First Line	:	6888 LINCOLN AVE
Second Line	:	STE J
City	:	BUENA PARK
State	:	CA
Zip	:	90620-4107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6888 LINCOLN AVE
Second Line	:	STE J
City	:	BUENA PARK
State	:	CA
Zip	:	90620-4107
Country	:	US
Telephone Number	:	714-821-7788
Fax Number	:	714-821-1369

Authorized Official
Title or Position	:	OWNER
Name	:	YOSHIO FUSE
Credential	:
Telephone Number	:	714-821-7788

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/29/2008

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Directions to “WELLTECH NETWORK INC ” Practice Location

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