Provider Demographics
NPI:1467855833
Name:WELLNESS PHARMACY
Entity Type:Organization
Organization Name:WELLNESS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUKITI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-278-3378
Mailing Address - Street 1:1039 W BALTIMORE ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-2523
Mailing Address - Country:US
Mailing Address - Phone:443-278-3378
Mailing Address - Fax:
Practice Address - Street 1:1039 W BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21223-2523
Practice Address - Country:US
Practice Address - Phone:443-278-3378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD176033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy