Provider Demographics
NPI:1467749838
Name:WELLNESS RX PHARMACY INC
Entity Type:Organization
Organization Name:WELLNESS RX PHARMACY INC
Other - Org Name:WELLNESS RX PHARMACY INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-226-8873
Mailing Address - Street 1:95 ELIZABETH ST FRNT B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-5210
Mailing Address - Country:US
Mailing Address - Phone:212-226-8873
Mailing Address - Fax:212-226-8891
Practice Address - Street 1:95 ELIZABETH ST FRNT B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-5210
Practice Address - Country:US
Practice Address - Phone:212-226-8873
Practice Address - Fax:212-226-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0308133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131001OtherPK
NY6584480001Medicare NSC