Provider Demographics
NPI:1407276264
Name:WELIA HEALTH
Entity Type:Organization
Organization Name:WELIA HEALTH
Other - Org Name:WELIA HEALTH COMMUNITY PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ULSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-679-1212
Mailing Address - Street 1:1425 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-6026
Mailing Address - Country:US
Mailing Address - Phone:320-322-5141
Mailing Address - Fax:320-322-5132
Practice Address - Street 1:1425 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-6026
Practice Address - Country:US
Practice Address - Phone:320-322-5141
Practice Address - Fax:320-322-5132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELIA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-21
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
MN2643873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2144876OtherPK
MN356680100Medicaid
7229150001Medicare NSC