MEDICARE: WELLNESS PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	49170	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2002338	OTHER		PK

General Provider Information

NPI Number	:	1366425233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS PHARMACY INC

Provider Business Mailing Address
First Line	:	7625 EASTERN AVE STE C
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-4515
Country	:	US
Telephone Number	:	323-773-3785
Fax Number	:	562-928-6275

Provider Business Practice Location Address
First Line	:	7625 EASTERN AVE STE C
Second Line	:
City	:	BELL GARDENS
State	:	CA
Zip	:	90201-4515
Country	:	US
Telephone Number	:	323-773-3800
Fax Number	:	562-928-6275

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YOUNG CHO
Credential	:
Telephone Number	:	626-318-3949

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	11/26/2014

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