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General NPI Number Information
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NPI Number | 1881973519
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Entity Type | Organization
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Legal Business Name | WELLNESS PHARMACY LLC
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Dates
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Enumeration Date | 08/11/2011
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Last Update Date | 10/07/2016
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Provider Practice Location Address
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Address Line | 1480 WILCREST DR
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City | HOUSTON
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State | TX
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Zip | 77042-2229
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Country | US
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Telephone | 713-532-0008
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Fax | 713-532-0020
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Provider Business Mailing Address
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Address Line | 1480 WILCREST DR
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City | HOUSTON
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State | TX
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Zip | 77042-2229
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Country | US
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Telephone | 713-532-0008
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Fax | 713-532-0020
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Authorized Official
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Title or Position | PIC
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Name | NGOZI AGATHA OBI
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Credential | PHARM D
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Telephone | 713-494-5262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 27586
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License Number State | TX
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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 | 27586
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License Number State | TX
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