MEDICARE: WHOLECARE PHARMACY, LLC

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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1831973569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLECARE PHARMACY, LLC

Provider Business Mailing Address
First Line	:	25602 INTERSTATE 45 STE 108
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1350
Country	:	US
Telephone Number	:	346-351-1025
Fax Number	:	888-342-7279

Provider Business Practice Location Address
First Line	:	25602 INTERSTATE 45 STE 108
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1350
Country	:	US
Telephone Number	:	346-351-1025
Fax Number	:	888-342-7279

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DALASI OWUSU
Credential	:
Telephone Number	:	713-835-5084

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/23/2023

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