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General NPI Number Information
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NPI Number | 1164041117
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Entity Type | Organization
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Legal Business Name | BE WELL PHARMACY CONSULTING LLC
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 1835 E PARK PLACE BLVD STE 105
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3457
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Country | US
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Telephone | 470-556-1136
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Fax |
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Provider Business Mailing Address
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Address Line | 1900 GLENN CLUB DR APT 922
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3471
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Country | US
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Telephone | 470-556-1136
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MESKEREM MAMO
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Credential | PHARMD
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Telephone | 470-556-1136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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