Provider Demographics
NPI:1679857924
Name:HEALTH & WELLNESS PHARMACY LLC
Entity Type:Organization
Organization Name:HEALTH & WELLNESS PHARMACY LLC
Other - Org Name:HEALTH & WELLNESS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PIC
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-530-0698
Mailing Address - Street 1:5050 BLAZER PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3361
Mailing Address - Country:US
Mailing Address - Phone:888-661-4497
Mailing Address - Fax:888-661-4497
Practice Address - Street 1:5050 BLAZER PKWY STE 202
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3376
Practice Address - Country:US
Practice Address - Phone:888-661-4497
Practice Address - Fax:888-661-4497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
OH0221263003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056492Medicaid
2132222OtherPK