Provider Demographics
NPI:1467598722
Name:WELLNESS PHARMACY INC
Entity Type:Organization
Organization Name:WELLNESS PHARMACY INC
Other - Org Name:MIDWAY DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUNG KYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:626-448-7659
Mailing Address - Street 1:10410 LOWER AZUSA RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1277
Mailing Address - Country:US
Mailing Address - Phone:626-448-7659
Mailing Address - Fax:626-443-8253
Practice Address - Street 1:10410 LOWER AZUSA RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1277
Practice Address - Country:US
Practice Address - Phone:626-448-7659
Practice Address - Fax:626-443-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 460763336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467598722OtherNPI
CAPHA46076Medicaid
CA4768340001Medicare NSC