Provider Demographics
NPI:1639734015
Name:WELLSMART PHARMACY SOUTH LLC
Entity Type:Organization
Organization Name:WELLSMART PHARMACY SOUTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:JUNEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-948-5113
Mailing Address - Street 1:539 E. PRUDHOMME ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570
Mailing Address - Country:US
Mailing Address - Phone:337-948-5113
Mailing Address - Fax:337-205-6366
Practice Address - Street 1:3939 I-49 S. SERVICE ROAD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0758
Practice Address - Country:US
Practice Address - Phone:337-447-4799
Practice Address - Fax:337-205-6366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy