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General NPI Number Information
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NPI Number | 1760927057
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Entity Type | Organization
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Legal Business Name | WELLCARE PHARMACY LLC
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Dates
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Enumeration Date | 12/22/2016
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Last Update Date | 03/23/2017
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Provider Practice Location Address
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Address Line | 9760 S KEDZIE AVE
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-3109
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Country | US
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Telephone | 708-930-5927
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Fax | 708-930-5935
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Provider Business Mailing Address
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Address Line | 9760 S KEDZIE AVE
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-3109
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Country | US
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Telephone | 708-930-5927
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Fax | 708-930-5935
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Authorized Official
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Title or Position | OWNER, AO, PHCY MANAGER, PIC
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Name | HANI ABDALLAH
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Credential | RPH
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Telephone | 708-307-7839
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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 | 054020144
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License Number State | IL
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