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General NPI Number Information
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NPI Number | 1639567605
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Entity Type | Organization
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Legal Business Name | WELLNESSRX PHARMACY CORPORATION
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Dates
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Enumeration Date | 12/29/2014
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 5971 UNIVERSITY AVE SUITE 304
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City | SAN DIEGO
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State | CA
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Zip | 92115-6335
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Country | US
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Telephone | 619-582-1933
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Fax | 619-582-1936
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Provider Business Mailing Address
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Address Line | 5971 UNIVERSITY AVE SUITE 304
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City | SAN DIEGO
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State | CA
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Zip | 92115-6335
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Country | US
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Telephone | 619-582-1933
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Fax | 619-582-1936
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHUONG-NGA THI PHAN
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Credential | PHARM,D.
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Telephone | 858-682-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State | CA
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