Provider Demographics
NPI:1417518218
Name:WELLNESS PHARMACY AND COMPOUNDING LLC
Entity Type:Organization
Organization Name:WELLNESS PHARMACY AND COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:GASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-817-6770
Mailing Address - Street 1:215 E BIG BEAVER RD STE 500
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1242
Mailing Address - Country:US
Mailing Address - Phone:248-817-6770
Mailing Address - Fax:248-817-2455
Practice Address - Street 1:215 E BIG BEAVER RD STE 500
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1242
Practice Address - Country:US
Practice Address - Phone:248-817-6770
Practice Address - Fax:248-817-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy