Provider Demographics
NPI:1598314403
Name:WELL CARE APOTHECARY, LLC
Entity Type:Organization
Organization Name:WELL CARE APOTHECARY, LLC
Other - Org Name:WELL CARE PHARMACY RENO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-410-7801
Mailing Address - Street 1:3312 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1829
Mailing Address - Country:US
Mailing Address - Phone:702-410-7825
Mailing Address - Fax:
Practice Address - Street 1:275 S WELLS AVE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1309
Practice Address - Country:US
Practice Address - Phone:775-313-0530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy