Provider Demographics
NPI:1619759693
Name:WELL CARE PHARMACY COMPANY LLC
Entity Type:Organization
Organization Name:WELL CARE PHARMACY COMPANY LLC
Other - Org Name:WELL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GAUTAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TALWAR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-681-0072
Mailing Address - Street 1:13137 RIVERS BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2699
Mailing Address - Country:US
Mailing Address - Phone:804-681-0072
Mailing Address - Fax:
Practice Address - Street 1:13137 RIVERS BEND BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-2699
Practice Address - Country:US
Practice Address - Phone:804-681-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy