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General NPI Number Information
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NPI Number | 1225127152
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Entity Type | Organization
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Legal Business Name | WELLCARE PHARMACY INC
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 9213 LAKESIDE BLVD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3859
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Country | US
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Telephone | 410-654-4441
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Fax | 410-654-4463
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Provider Business Mailing Address
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Address Line | 9213 LAKESIDE BLVD
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3859
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Country | US
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Telephone | 410-654-4441
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Fax | 410-654-4463
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Authorized Official
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Title or Position | OWNER / PRESIDENT/PHARMACY MGR
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Name | DR. TEMITOPE OULWAYEMISI GBOLAGUN
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Credential |
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Telephone | 410-654-4441
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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 | P04406
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License Number State | MD
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