Provider Demographics
NPI:1407230675
Name:WELLPLUS PHARMACY INC.
Entity Type:Organization
Organization Name:WELLPLUS PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:HUSAM
Authorized Official - Last Name:MAHMOUD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:559-259-8454
Mailing Address - Street 1:1187 N WILLOW AVE
Mailing Address - Street 2:STE 103 #42
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4411
Mailing Address - Country:US
Mailing Address - Phone:559-765-4364
Mailing Address - Fax:559-765-4556
Practice Address - Street 1:3005 W BULLARD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-1609
Practice Address - Country:US
Practice Address - Phone:559-765-4364
Practice Address - Fax:559-765-4556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy