MEDICARE: WELLGISTICS PHARMACY, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	3336C0003X	Community/Retail Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336M0002X	Mail Order Pharmacy
4	333600000X	Pharmacy

General Provider Information

NPI Number	:	1417579863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLGISTICS PHARMACY, LLC

Provider Business Mailing Address
First Line	:	354 EAGLES LANDING DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-2999
Country	:	US
Telephone Number	:	844-251-4691
Fax Number	:	844-522-0354

Provider Business Practice Location Address
First Line	:	354 EAGLES LANDING DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33810-2999
Country	:	US
Telephone Number	:	844-251-4691
Fax Number	:	844-522-0354

Authorized Official
Title or Position	:	CHIEF PHARMACY OFFICER/PIC
Name	:	NIKUL R PANCHAL
Credential	:
Telephone Number	:	813-482-7700

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	12/16/2025

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