MEDICARE: VI WELLNESS 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
1	3336C0004X	Compounding Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1568334035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VI WELLNESS LLC

Provider Business Mailing Address
First Line	:	8752 MEDICAL CITY WAY STE 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2497
Country	:	US
Telephone Number	:	682-710-7777
Fax Number	:	844-328-4814

Provider Business Practice Location Address
First Line	:	8752 MEDICAL CITY WAY STE 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-2497
Country	:	US
Telephone Number	:	682-710-7777
Fax Number	:	844-328-4814

Authorized Official
Title or Position	:	OWNER
Name	:	ASHOK POTHULA
Credential	:	RPH
Telephone Number	:	682-710-7777

Provider Enumeration Date	:	09/23/2025
Last Update Date	:	11/17/2025

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Directions to “VI WELLNESS LLC ” Practice Location

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