Provider Demographics
NPI:1609166198
Name:ALL WELL PHARMACY INC
Entity Type:Organization
Organization Name:ALL WELL PHARMACY INC
Other - Org Name:ALL WELL PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUMANTH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:EDARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-779-6990
Mailing Address - Street 1:5452 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1957
Mailing Address - Country:US
Mailing Address - Phone:904-779-6990
Mailing Address - Fax:904-779-6995
Practice Address - Street 1:5452 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-1957
Practice Address - Country:US
Practice Address - Phone:904-779-6990
Practice Address - Fax:904-779-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH253973336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003613300Medicaid
2129850OtherPK