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General NPI Number Information
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NPI Number | 1831509934
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Entity Type | Organization
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Legal Business Name | WELLCARE PHARMACY
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 3923 S CAPITOL ST SW UNIT A
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City | WASHINGTON
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State | DC
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Zip | 20032-2308
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Country | US
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Telephone | 202-847-0237
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Fax |
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Provider Business Mailing Address
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Address Line | 3923 S CAPITOL ST SW UNIT A
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City | WASHINGTON
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State | DC
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Zip | 20032-2308
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Country | US
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Telephone | 202-847-0237
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | REDIET TAYE
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Credential | PHARMD
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Telephone | 202-262-9328
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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 | RX0000058
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License Number State | DC
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