Healthcare Provider Details

I. General information

NPI: 1447735220
Provider Name (Legal Business Name): WELLNESS HEALTH MART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11780 TELEGRAPH RD STE 110
TAYLOR MI
48180-6861
US

IV. Provider business mailing address

11780 TELEGRAPH RD STE 110
TAYLOR MI
48180-6861
US

V. Phone/Fax

Practice location:
  • Phone: 734-921-3971
  • Fax: 734-921-3172
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MAHER SALAMEH
Title or Position: OWNER PIC
Credential: PHARM D.
Phone: 734-921-3971