Provider Demographics
NPI:1073934915
Name:WELLCARE PHARMACY
Entity Type:Organization
Organization Name:WELLCARE PHARMACY
Other - Org Name:WELLCARE PHARMACY LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-444-3632
Mailing Address - Street 1:180 SCOTLAND RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07050-1443
Mailing Address - Country:US
Mailing Address - Phone:862-444-3632
Mailing Address - Fax:
Practice Address - Street 1:180 SCOTLAND RD
Practice Address - Street 2:SUITE #4
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-1443
Practice Address - Country:US
Practice Address - Phone:862-444-3632
Practice Address - Fax:862-444-3942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-19
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0673170Medicaid