Healthcare Provider Details

I. General information

NPI: 1083028815
Provider Name (Legal Business Name): WELLCARE COMPOUNDING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 ELIZABETH BRADY RD
HILLSBOROUGH NC
27278-9540
US

IV. Provider business mailing address

346 ELIZABETH BRADY RD
HILLSBOROUGH NC
27278-9540
US

V. Phone/Fax

Practice location:
  • Phone: 919-245-3222
  • Fax: 919-245-3230
Mailing address:
  • Phone: 919-245-3222
  • Fax: 919-245-3230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHNR000199
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number12537
License Number StateNC

VIII. Authorized Official

Name: ASHLEY BELL
Title or Position: PIC
Credential: PHARMD
Phone: 919-245-3222