Provider Demographics
NPI:1457319469
Name:WAKEEM INC
Entity Type:Organization
Organization Name:WAKEEM INC
Other - Org Name:BELL APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-258-2311
Mailing Address - Street 1:2045 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042
Mailing Address - Country:US
Mailing Address - Phone:610-258-2311
Mailing Address - Fax:610-252-0972
Practice Address - Street 1:2045 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042
Practice Address - Country:US
Practice Address - Phone:610-258-2311
Practice Address - Fax:610-252-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
283036OtherOTHER MICELLANEOUS INS
39HA31OtherCAPITAL BLUE CROSS
80530OtherUNISON
0010448410001OtherPA MEDICAL ASSISTANCE
1404974OtherHIGHMARK BLUE SHIELD
PA0010448410001Medicaid
0010448410001OtherPA WAIVER PROGRAM
PA0010448410001Medicaid
0010448410001OtherPA MEDICAL ASSISTANCE