Provider Demographics
NPI:1245604420
Name:WELLNESS RX TAMPA LLC
Entity Type:Organization
Organization Name:WELLNESS RX TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY AFFLIATED
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-648-6857
Mailing Address - Street 1:7208 N STERLING AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4228
Mailing Address - Country:US
Mailing Address - Phone:813-867-4330
Mailing Address - Fax:866-692-0144
Practice Address - Street 1:7208 N STERLING AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4228
Practice Address - Country:US
Practice Address - Phone:813-867-4330
Practice Address - Fax:866-692-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-25
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH265373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy