Provider Demographics
NPI:1659375210
Name:WAKEEM INC
Entity Type:Organization
Organization Name:WAKEEM INC
Other - Org Name:BELL APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANNE.
Authorized Official - Middle Name:E
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:610-258-2311
Mailing Address - Street 1:2045 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3915
Mailing Address - Country:US
Mailing Address - Phone:610-258-2311
Mailing Address - Fax:610-252-0972
Practice Address - Street 1:2045 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3915
Practice Address - Country:US
Practice Address - Phone:610-258-2311
Practice Address - Fax:610-252-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP412543L183500000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3928629OtherNCPDP
PA1523031OtherGATEWAY
PA80530OtherMED PLUS
39HA31OtherCAPITAL BLUE CROSS
HIGHMARKOtherDME INSURANCE
PA0010448410001Medicaid
2830306OtherALL OTHER INSURANCE