Healthcare Provider Details

I. General information

NPI: 1194330795
Provider Name (Legal Business Name): BEWELLRX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 04/28/2023
Certification Date: 04/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21102 DEVONSHIRE ST
CHATSWORTH CA
91311-2316
US

IV. Provider business mailing address

21102 DEVONSHIRE ST
CHATSWORTH CA
91311-2316
US

V. Phone/Fax

Practice location:
  • Phone: 818-640-0093
  • Fax:
Mailing address:
  • Phone: 818-640-0093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NILOOFAR SHEIKHAN
Title or Position: PIC/CFO
Credential:
Phone: 310-990-3432