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General NPI Number Information
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NPI Number | 1225339021
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Entity Type | Organization
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Legal Business Name | ALLWELL PHARMACY AND MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 07/02/2014
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Provider Practice Location Address
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Address Line | 5611 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95824-1611
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Country | US
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Telephone | 916-457-2905
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Fax | 916-457-2140
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Provider Business Mailing Address
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Address Line | 5611 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95824-1611
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Country | US
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Telephone | 916-457-2905
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Fax | 916-457-2140
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | CLETUS DURU
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Credential | PHARM.D
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Telephone | 916-690-3585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 50426
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License Number State | CA
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