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General NPI Number Information
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NPI Number | 1356498406
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Entity Type | Organization
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Legal Business Name | PSR WELLNESS LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 1390 RAILROAD AVE
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City | SAINT HELENA
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State | CA
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Zip | 94574-1124
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Country | US
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Telephone | 707-963-2794
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Fax | 707-963-1954
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Provider Business Mailing Address
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Address Line | 1390 RAILROAD AVE
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City | SAINT HELENA
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State | CA
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Zip | 94574-1124
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Country | US
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Telephone | 707-963-2794
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Fax | 707-963-1954
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Authorized Official
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Title or Position | MANAGER
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Name | MR. PRATAP KRISHNA ANNE
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Credential |
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Telephone | 209-298-1715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY40633
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License Number State | CA
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