Provider Demographics
NPI:1689250029
Name:GETWELL PHARMACY, LLC
Entity Type:Organization
Organization Name:GETWELL PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-655-1437
Mailing Address - Street 1:5779 GETWELL RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-6349
Mailing Address - Country:US
Mailing Address - Phone:662-655-1437
Mailing Address - Fax:
Practice Address - Street 1:8857 GOODMAN RD STE D
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2203
Practice Address - Country:US
Practice Address - Phone:662-655-1437
Practice Address - Fax:662-510-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy