Provider Demographics
NPI:1457850125
Name:WELLPATHRX INC
Entity Type:Organization
Organization Name:WELLPATHRX INC
Other - Org Name:PARK MESA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-319-4653
Mailing Address - Street 1:4314 W SLAUSON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-2808
Mailing Address - Country:US
Mailing Address - Phone:323-378-3323
Mailing Address - Fax:323-378-3324
Practice Address - Street 1:4314 W SLAUSON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-2808
Practice Address - Country:US
Practice Address - Phone:323-378-3323
Practice Address - Fax:323-378-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CA559873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2175520OtherPK