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General NPI Number Information
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NPI Number | 1811201452
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Entity Type | Organization
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Legal Business Name | WELLNESS PHARMACY INC
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Dates
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Enumeration Date | 08/05/2010
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 120 W BOUGAINVILLEA AVE
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City | TAMPA
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State | FL
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Zip | 33612-7437
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Country | US
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Telephone | 813-774-8856
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Fax | 813-319-3760
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Provider Business Mailing Address
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Address Line | 120 W BOUGAINVILLEA AVE
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City | TAMPA
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State | FL
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Zip | 33612-7437
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Country | US
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Telephone | 813-774-8856
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Fax | 813-319-3760
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Authorized Official
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Title or Position | OWNER/PIC/AO
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Name | GASHAW ADANE
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Credential | BPHARM
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Telephone | 813-408-4097
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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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH24665
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License Number State | FL
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