MEDICARE: AJ WELLNESS PHARMACY 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1740860444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AJ WELLNESS PHARMACY LLC

Provider Business Mailing Address
First Line	:	9785 MACKENZIE RD STE 106
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-5438
Country	:	US
Telephone Number	:	314-875-9002
Fax Number	:	314-875-9005

Provider Business Practice Location Address
First Line	:	9785 MACKENZIE RD STE 106
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63123-5438
Country	:	US
Telephone Number	:	314-875-9002
Fax Number	:	314-875-9005

Authorized Official
Title or Position	:	OWNER
Name	:	AMIRA JAHIC
Credential	:
Telephone Number	:	314-875-9002

Provider Enumeration Date	:	04/08/2021
Last Update Date	:	09/12/2022

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