Healthcare Provider Details

I. General information

NPI: 1215473939
Provider Name (Legal Business Name): MISSION WELLNESS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVE STE 505
SAN FRANCISCO CA
94117-3628
US

IV. Provider business mailing address

PO 7775 #52191
SAN FRANCISCO CA
94120
US

V. Phone/Fax

Practice location:
  • Phone: 415-926-6270
  • Fax: 415-826-7077
Mailing address:
  • Phone: 415-577-4743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number55442
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ANDRZEJEK
Title or Position: CEO
Credential:
Phone: 415-577-4743