Provider Demographics
NPI:1710263462
Name:WELL CARE PHARMACY OF LONGISLAND CORP.
Entity Type:Organization
Organization Name:WELL CARE PHARMACY OF LONGISLAND CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAHEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PERVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-249-5900
Mailing Address - Street 1:1011-45 RT 109
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4700
Mailing Address - Country:US
Mailing Address - Phone:516-249-5900
Mailing Address - Fax:516-249-5902
Practice Address - Street 1:1037 FULTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4700
Practice Address - Country:US
Practice Address - Phone:516-249-5900
Practice Address - Fax:516-249-5902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty