Provider Demographics
NPI:1508121179
Name:WESLEY PHARMACY
Entity Type:Organization
Organization Name:WESLEY PHARMACY
Other - Org Name:WESLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:EKECHUKEU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-580-1408
Mailing Address - Street 1:5711 BISSONNET ST
Mailing Address - Street 2:SUITE#F
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4725
Mailing Address - Country:US
Mailing Address - Phone:713-838-1500
Mailing Address - Fax:713-838-1505
Practice Address - Street 1:5711 BISSONNET ST STE F
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4724
Practice Address - Country:US
Practice Address - Phone:713-838-1500
Practice Address - Fax:713-838-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX281113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5906423OtherNCPDP PROVIDER IDENTIFICATION NUMBER