Provider Demographics
NPI:1760677785
Name:WELLNESS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:WELLNESS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:KELLEHER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:978-443-4523
Mailing Address - Street 1:345 BOSTON POST RD # A
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3033
Mailing Address - Country:US
Mailing Address - Phone:978-443-4523
Mailing Address - Fax:978-443-4598
Practice Address - Street 1:345 BOSTON POST RD # A
Practice Address - Street 2:SUITE 28
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3033
Practice Address - Country:US
Practice Address - Phone:978-443-4523
Practice Address - Fax:978-443-4598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6054320001Medicare NSC