Provider Demographics
NPI:1225574742
Name:WELLNESS PLUS LLC
Entity Type:Organization
Organization Name:WELLNESS PLUS LLC
Other - Org Name:WELLNESS PLUS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:BOLA
Authorized Official - Last Name:ADEYEMO
Authorized Official - Suffix:
Authorized Official - Credentials:BSC
Authorized Official - Phone:201-674-9612
Mailing Address - Street 1:1076 SPRINGFIELD AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-2467
Mailing Address - Country:US
Mailing Address - Phone:973-399-1150
Mailing Address - Fax:973-399-1143
Practice Address - Street 1:1076 SPRINGFIELD AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-2467
Practice Address - Country:US
Practice Address - Phone:973-399-1150
Practice Address - Fax:973-399-1143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-08
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00753800333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy