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General NPI Number Information
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NPI Number | 1154805422
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Entity Type | Organization
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Legal Business Name | WELLNESSSCRIPTRX
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 159 N JACKSON ST STE 105
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City | MILWAUKEE
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State | WI
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Zip | 53202-6169
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Country | US
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Telephone | 855-988-4900
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Fax | 855-998-4910
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Provider Business Mailing Address
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Address Line | 159 N JACKSON ST STE 105
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City | MILWAUKEE
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State | WI
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Zip | 53202-6169
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Country | US
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Telephone | 414-409-8195
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALEX YAMPOLSKY
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Credential | PHARMD
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Telephone | 414-409-8195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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