Provider Demographics
NPI:1558045971
Name:WELLCARE HEALTHCARE PHARMACY INC
Entity Type:Organization
Organization Name:WELLCARE HEALTHCARE PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BHAVESHKUMAR
Authorized Official - Middle Name:B
Authorized Official - Last Name:PANSARA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:817-733-1628
Mailing Address - Street 1:9493 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3765
Mailing Address - Country:US
Mailing Address - Phone:951-299-7100
Mailing Address - Fax:
Practice Address - Street 1:9493 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3765
Practice Address - Country:US
Practice Address - Phone:951-299-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLCARE HEALTHCARE PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy