=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255789970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH & WELLNESS FARMACIA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2016
-----------------------------------------------------
Last Update Date | 05/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 634 FULTON AVE
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-4544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-280-2260
-----------------------------------------------------
Fax | 516-280-2261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 634 FULTON AVE
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-4544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-280-2260
-----------------------------------------------------
Fax | 516-280-2261
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ZIA U KHAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-280-2260
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 034789
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------