{
"Npi": {
"NPI": "1114809605",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "WELLSCRIPT PHARMACY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "36400 WOODWARD AVE STE 60",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BLOOMFIELD TOWNSHIP",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48304-0911",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "248-792-7059",
"MailingAddressFaxNumber": "248-792-7216",
"FirstLinePracticeLocationAddress": "36400 WOODWARD AVE STE 60",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLOOMFIELD TOWNSHIP",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48304-0911",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-792-7059",
"PracticeLocationAddressFaxNumber": "248-792-7216",
"EnumerationDate": "07/24/2025",
"LastUpdateDate": "07/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "FARHAT",
"AuthorizedOfficialFirstName": "MOUHAMAD",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OWNER/PIC",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PHARMD",
"AuthorizedOfficialTelephoneNumber": "313-999-0373",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "3336C0003X",
"TaxonomyName": "Community/Retail Pharmacy",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}