Healthcare Provider Details

I. General information

NPI: 1952224735
Provider Name (Legal Business Name): ALLIANCE WELLNESS TX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8666 PLUTO TER
LAKE PARK FL
33403-1657
US

IV. Provider business mailing address

8666 PLUTO TER
LAKE PARK FL
33403-1657
US

V. Phone/Fax

Practice location:
  • Phone: 282-018-6517
  • Fax:
Mailing address:
  • Phone: 282-018-6517
  • 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: CATHERINE THOMPSON
Title or Position: MANAGER
Credential:
Phone: 282-018-6517