Healthcare Provider Details

I. General information

NPI: 1841989969
Provider Name (Legal Business Name): WELLNESS RX CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4538 EDMONDSON AVE
BALTIMORE MD
21229-1506
US

IV. Provider business mailing address

300 E LOMBARD ST STE 1700
BALTIMORE MD
21202-3243
US

V. Phone/Fax

Practice location:
  • Phone: 443-872-2230
  • Fax:
Mailing address:
  • Phone: 410-227-9426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. LAUREN HERRON
Title or Position: COO
Credential: LCSW-C
Phone: 410-227-9426