Healthcare Provider Details

I. General information

NPI: 1417579863
Provider Name (Legal Business Name): WELLGISTICS PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 EAGLES LANDING DR
LAKELAND FL
33810-2999
US

IV. Provider business mailing address

354 EAGLES LANDING DR
LAKELAND FL
33810-2999
US

V. Phone/Fax

Practice location:
  • Phone: 844-251-4691
  • Fax: 844-522-0354
Mailing address:
  • Phone: 844-251-4691
  • Fax: 844-522-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: NIKUL R PANCHAL
Title or Position: CHIEF PHARMACY OFFICER/PIC
Credential:
Phone: 813-482-7700