Healthcare Provider Details

I. General information

NPI: 1487361168
Provider Name (Legal Business Name): WELLNESS ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 E PIKES PEAK AVE
COLORADO SPRINGS CO
80909-5906
US

IV. Provider business mailing address

2620 S PARKER RD STE 160
AURORA CO
80014-1676
US

V. Phone/Fax

Practice location:
  • Phone: 719-428-2003
  • Fax: 719-358-7465
Mailing address:
  • Phone: 720-939-6070
  • Fax: 719-358-7465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE OTU ONWA
Title or Position: PRESIDENT
Credential:
Phone: 720-939-6070