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General NPI Number Information
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NPI Number | 1548307648
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Entity Type | Organization
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Legal Business Name | WELAKA PHARMACY LLC
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/05/2013
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Provider Practice Location Address
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Address Line | 698 THIRD AVENUE
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City | WELAKA
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State | FL
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Zip | 32193
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Country | US
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Telephone | 386-467-9994
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Fax | 386-467-3112
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Provider Business Mailing Address
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Address Line | 698 THIRD AVE
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City | WELAKA
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State | FL
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Zip | 32193
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Country | US
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Telephone | 386-467-9994
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Fax | 386-467-3112
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Authorized Official
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Title or Position | P
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Name | THOMAS P BALL
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Credential | RPH
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Telephone | 386-467-9994
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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 | PH16228
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License Number State | FL
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