Provider Demographics
NPI:1003164450
Name:WELLNESS PLUS PHARMACY INC
Entity Type:Organization
Organization Name:WELLNESS PLUS PHARMACY INC
Other - Org Name:WELLNESS PLUS PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ADEDAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEYEYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-286-2432
Mailing Address - Street 1:16610 FOSTER POINT LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-5519
Mailing Address - Country:US
Mailing Address - Phone:832-286-2432
Mailing Address - Fax:832-604-7420
Practice Address - Street 1:13141 FM 1960 RD W STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5279
Practice Address - Country:US
Practice Address - Phone:832-604-7418
Practice Address - Fax:832-604-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX281703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2136501OtherPK
TX146669Medicaid