Healthcare Provider Details

I. General information

NPI: 1356269518
Provider Name (Legal Business Name): WELLINGTON PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2201 WILTON DR
WILTON MANORS FL
33305-2140
US

IV. Provider business mailing address

2201 WILTON DR
WILTON MANORS FL
33305-2140
US

V. Phone/Fax

Practice location:
  • Phone: 954-545-2355
  • Fax: 844-826-3873
Mailing address:
  • Phone: 954-545-2355
  • Fax: 844-826-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JACOB DAVID VANDEVENTER
Title or Position: CFO
Credential: PHARMD
Phone: 813-780-7216