Healthcare Provider Details

I. General information

NPI: 1558045971
Provider Name (Legal Business Name): WELLCARE HEALTHCARE PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9493 GARFIELD ST
RIVERSIDE CA
92503-3765
US

IV. Provider business mailing address

9493 GARFIELD ST
RIVERSIDE CA
92503-3765
US

V. Phone/Fax

Practice location:
  • Phone: 951-299-7100
  • Fax:
Mailing address:
  • Phone: 951-299-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BHAVESHKUMAR B PANSARA
Title or Position: PHARMACIST
Credential: PHARMACIST
Phone: 817-733-1628