Healthcare Provider Details

I. General information

NPI: 1598634677
Provider Name (Legal Business Name): WELLPATH PHARMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18505 GRAND RIVER AVE
DETROIT MI
48223-2318
US

IV. Provider business mailing address

18505 GRAND RIVER AVE
DETROIT MI
48223-2318
US

V. Phone/Fax

Practice location:
  • Phone: 313-200-0200
  • Fax: 313-200-0222
Mailing address:
  • Phone: 313-200-0200
  • Fax: 313-200-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LAURENA HAZEM CHAHINE
Title or Position: OWNER/PIC
Credential:
Phone: 313-200-0200