Provider Demographics
NPI:1154465797
Name:HEALTH & WELLNESS PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:HEALTH & WELLNESS PROFESSIONALS, INC.
Other - Org Name:HEALTH & WELLNESS COMPOUNDING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARTHOLOMEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-522-0555
Mailing Address - Street 1:220 13TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1604
Mailing Address - Country:US
Mailing Address - Phone:304-522-0555
Mailing Address - Fax:304-522-8005
Practice Address - Street 1:220 13TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-1604
Practice Address - Country:US
Practice Address - Phone:304-522-0555
Practice Address - Fax:304-522-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSP05523183336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810003826Medicaid
KY54011341Medicaid
OH2606942Medicaid
WV3810003826Medicaid