Provider Demographics
NPI:1164932273
Name:ALLWELL PHARMACY INC.
Entity Type:Organization
Organization Name:ALLWELL PHARMACY INC.
Other - Org Name:ALLWELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-331-7964
Mailing Address - Street 1:4430 EGRET AVE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-4769
Mailing Address - Country:US
Mailing Address - Phone:770-331-7964
Mailing Address - Fax:
Practice Address - Street 1:1235 INDIAN TRAIL LILBURN RD STE B401
Practice Address - Street 2:SUITE- B 401
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5524
Practice Address - Country:US
Practice Address - Phone:770-331-7964
Practice Address - Fax:770-864-5645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
GAPHRE0103873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2170238OtherPK