Provider Demographics
NPI:1679848113
Name:ABSOLUTE WELLCARE LLC
Entity Type:Organization
Organization Name:ABSOLUTE WELLCARE LLC
Other - Org Name:ABSOLUTE WELLCARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPPERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-779-8648
Mailing Address - Street 1:15800 ARMINTA ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-1918
Mailing Address - Country:US
Mailing Address - Phone:818-779-8648
Mailing Address - Fax:818-779-8672
Practice Address - Street 1:15800 ARMINTA ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-1918
Practice Address - Country:US
Practice Address - Phone:818-779-8648
Practice Address - Fax:818-779-8672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-16
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA590293336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5643742OtherNCPDP PROVIDER IDENTIFICATION NUMBER