Healthcare Provider Details

I. General information

NPI: 1689250029
Provider Name (Legal Business Name): GETWELL PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8857 GOODMAN RD STE D
OLIVE BRANCH MS
38654-2203
US

IV. Provider business mailing address

5779 GETWELL RD BLDG B
SOUTHAVEN MS
38672-6349
US

V. Phone/Fax

Practice location:
  • Phone: 662-655-1437
  • Fax: 662-510-2197
Mailing address:
  • Phone: 662-655-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAN CORDELL
Title or Position: OWNER
Credential:
Phone: 662-655-1437