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NPI Code Detail

MEDICARE: WELLNESS ENTERPRISES LLC

MEDICARE: WELLNESS ENTERPRISES LLC
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
13336C0003XCommunity/Retail Pharmacy
23336C0004XCompounding Pharmacy
33336M0002XMail Order Pharmacy
4332B00000XDurable Medical Equipment & Medical Supplies
51835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
114374906OTHERCOSECRETARY OF STATE

General Provider Information

NPI Number : 1487361168
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLNESS ENTERPRISES LLC
Provider Business Mailing Address
First Line : 2620 S PARKER RD STE 160
Second Line :
City : AURORA
State : CO
Zip : 80014-1676
Country : US
Telephone Number : 720-939-6070
Fax Number : 719-358-7465
Provider Business Practice Location Address
First Line : 2224 E PIKES PEAK AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-5906
Country : US
Telephone Number : 719-428-2003
Fax Number : 719-358-7465
Authorized Official
Title or Position : PRESIDENT
Name : LAWRENCE OTU ONWA
Credential :
Telephone Number : 720-939-6070
Provider Enumeration Date : 11/01/2022
Last Update Date : 11/01/2022

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Directions to “WELLNESS ENTERPRISES LLC ” Practice Location

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