Provider Demographics
NPI:1336468511
Name:WELLCARE PHARMACY SERVICES INC
Entity Type:Organization
Organization Name:WELLCARE PHARMACY SERVICES INC
Other - Org Name:WELLCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALPESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-391-5533
Mailing Address - Street 1:13733 N. US HWY 441
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-391-5533
Mailing Address - Fax:352-391-5531
Practice Address - Street 1:13733 N US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8981
Practice Address - Country:US
Practice Address - Phone:352-391-5533
Practice Address - Fax:352-391-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163WD0400X, 3336C0004X, 3336S0011X
FLPH246633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No3336C0004XSuppliersPharmacyCompounding PharmacyGroup - Multi-Specialty
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5700213OtherNCPDP PROVIDER IDENTIFICATION NUMBER