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General NPI Number Information
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NPI Number | 1225933468
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Entity Type | Organization
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Legal Business Name | OPTIMUM WELLNESS CENTER
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Dates
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Enumeration Date | 10/08/2026
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Last Update Date | 10/08/2026
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Provider Practice Location Address
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Address Line | 716 BROADWAY ST
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1357
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Country | US
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Telephone | 606-220-2553
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Fax | 606-220-2554
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Provider Business Mailing Address
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Address Line | 716 BROADWAY ST
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City | PAINTSVILLE
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State | KY
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Zip | 41240-1357
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Country | US
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Telephone | 606-220-2553
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Fax | 606-220-2554
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW SAMMONS
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Credential |
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Telephone | 606-220-2553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | NULL
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