Provider Demographics
NPI:1407906506
Name:THE WELLNESS CENTER PHARMACY, INC.
Entity Type:Organization
Organization Name:THE WELLNESS CENTER PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:423-954-2585
Mailing Address - Street 1:7304 JARNIGAN RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3042
Mailing Address - Country:US
Mailing Address - Phone:423-954-2585
Mailing Address - Fax:423-954-2460
Practice Address - Street 1:7304 JARNIGAN RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3042
Practice Address - Country:US
Practice Address - Phone:423-954-2585
Practice Address - Fax:423-954-2460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3071760OtherTN PROVIDER PHARMACY ID #
TN3203OtherPHARMACY STATE LICENSE
TN4431780OtherNAPB
TN3100789OtherTN PROVIDER SUPPLY ID #
TNBT7092656OtherDEA LICENSE
TN3100789OtherTN PROVIDER SUPPLY ID #