Provider Demographics
NPI:1497035992
Name:GET-WELL PHARMACY LLC
Entity Type:Organization
Organization Name:GET-WELL PHARMACY LLC
Other - Org Name:EXPRESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:BS RPH
Authorized Official - Phone:301-676-5876
Mailing Address - Street 1:EXPRESS PHARMACY #1
Mailing Address - Street 2:117 IVY HILL DR
Mailing Address - City:MIDDLETOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21769
Mailing Address - Country:US
Mailing Address - Phone:301-676-5876
Mailing Address - Fax:301-790-1333
Practice Address - Street 1:EXPRESS PHARMACY #1
Practice Address - Street 2:117 IVY HILL DR
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6704
Practice Address - Country:US
Practice Address - Phone:301-790-1233
Practice Address - Fax:301-790-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MDP055733336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2131726OtherPK
MD6618390001Medicare NSC