Healthcare Provider Details

I. General information

NPI: 1891102448
Provider Name (Legal Business Name): WELLCARE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

693 E 18TH ST
PATERSON NJ
07501-2375
US

IV. Provider business mailing address

693 E 18TH ST
PATERSON NJ
07501-2375
US

V. Phone/Fax

Practice location:
  • Phone: 973-925-7757
  • Fax: 973-925-7758
Mailing address:
  • Phone: 973-925-7757
  • Fax: 973-925-7758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RS00734400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GITA LAVANI
Title or Position: PRESIDENT
Credential:
Phone: 201-428-8930