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General NPI Number Information
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NPI Number | 1861187833
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Entity Type | Organization
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Legal Business Name | BEWELL LLC
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 5346 MADISON AVE STE A
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City | SACRAMENTO
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State | CA
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Zip | 95841-3168
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Country | US
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Telephone | 916-800-6004
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Fax | 916-249-1449
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Provider Business Mailing Address
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Address Line | 5346 MADISON AVE STE A
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City | SACRAMENTO
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State | CA
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Zip | 95841-3168
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Country | US
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Telephone | 916-800-6004
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER/CEO
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Name | MR. DEMITRI DUKHOVNY
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Credential |
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Telephone | 858-218-3330
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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 |
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