Provider Demographics
NPI:1891700415
Name:WELLNES HEALTHCARE MARKETING INC
Entity Type:Organization
Organization Name:WELLNES HEALTHCARE MARKETING INC
Other - Org Name:HOLLYWOOD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLEMENT
Authorized Official - Middle Name:
Authorized Official - Last Name:ADENUPEBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-345-3400
Mailing Address - Street 1:9901 RHODE ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1424
Mailing Address - Country:US
Mailing Address - Phone:301-345-3400
Mailing Address - Fax:301-345-2444
Practice Address - Street 1:9901 RHODE ISLAND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1424
Practice Address - Country:US
Practice Address - Phone:301-345-3400
Practice Address - Fax:301-345-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP043973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2038162OtherPK
MD409730100Medicaid
5614850001Medicare NSC