Healthcare Provider Details

I. General information

NPI: 1902202898
Provider Name (Legal Business Name): WELLNESS PHARMACY OF ST AUGUSTINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 SARTILLO RD SUITE B
ST AUGUSTINE FL
32095-5240
US

IV. Provider business mailing address

4405 SARTILLO RD SUITE B
ST AUGUSTINE FL
32095-5240
US

V. Phone/Fax

Practice location:
  • Phone: 904-429-7333
  • Fax: 904-460-2695
Mailing address:
  • Phone: 904-429-7333
  • Fax: 904-460-2695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26918
License Number StateFL

VIII. Authorized Official

Name: DINO AJLONI
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 904-429-7333