Provider Demographics
NPI:1629697453
Name:WHOLISTIC MTM, INC.
Entity Type:Organization
Organization Name:WHOLISTIC MTM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:SEWALEM
Authorized Official - Middle Name:
Authorized Official - Last Name:MEBRATE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:901-517-2867
Mailing Address - Street 1:806 ASHLEY LN
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6143
Mailing Address - Country:US
Mailing Address - Phone:470-353-0019
Mailing Address - Fax:
Practice Address - Street 1:806 ASHLEY LN
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6143
Practice Address - Country:US
Practice Address - Phone:470-353-0019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty