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General NPI Number Information
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NPI Number | 1902202898
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Entity Type | Organization
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Legal Business Name | WELLNESS PHARMACY OF ST AUGUSTINE LLC
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Dates
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Enumeration Date | 11/05/2014
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Last Update Date | 11/05/2014
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Provider Practice Location Address
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Address Line | 4405 SARTILLO RD SUITE B
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-5240
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Country | US
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Telephone | 904-429-7333
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Fax | 904-460-2695
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Provider Business Mailing Address
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Address Line | 4405 SARTILLO RD SUITE B
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City | ST AUGUSTINE
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State | FL
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Zip | 32095-5240
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Country | US
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Telephone | 904-429-7333
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Fax | 904-460-2695
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Authorized Official
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Title or Position | PHARMACIST
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Name | DINO AJLONI
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Credential | PHARMD
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Telephone | 904-429-7333
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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 | PH26918
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License Number State | FL
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