Healthcare Provider Details

I. General information

NPI: 1033575592
Provider Name (Legal Business Name): MTWELCOME PHARMACY PRINCESSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 LA GRANDE PRINCESS
CHRISTIANSTED VI
00820
US

IV. Provider business mailing address

4040 ESTATE LA GRANDE PRINCESS
CHRISTIANSTED VI
00820-5165
US

V. Phone/Fax

Practice location:
  • Phone: 340-719-7979
  • Fax: 340-713-3118
Mailing address:
  • Phone: 340-719-7979
  • Fax: 340-713-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2-13924-3L
License Number StateVI

VIII. Authorized Official

Name: RONNIE HARVEY
Title or Position: PHARMACIST
Credential:
Phone: 540-890-3409