Provider Demographics
NPI:1346951480
Name:REPLENISH WELLNESS CONSULTING LLC
Entity Type:Organization
Organization Name:REPLENISH WELLNESS CONSULTING LLC
Other - Org Name:ESSENTIAL APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:917-696-3200
Mailing Address - Street 1:1 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CARLE PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11514-1801
Mailing Address - Country:US
Mailing Address - Phone:516-287-2002
Mailing Address - Fax:
Practice Address - Street 1:1 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CARLE PLACE
Practice Address - State:NY
Practice Address - Zip Code:11514-1801
Practice Address - Country:US
Practice Address - Phone:516-287-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-09
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039938Medicaid