Provider Demographics
NPI:1891899852
Name:THE WELLNESS PLAN
Entity Type:Organization
Organization Name:THE WELLNESS PLAN
Other - Org Name:THE WELLNESS PLAN MEDICAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:248-967-6604
Mailing Address - Street 1:21040 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-3025
Mailing Address - Country:US
Mailing Address - Phone:248-967-6604
Mailing Address - Fax:248-967-6506
Practice Address - Street 1:21040 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-3025
Practice Address - Country:US
Practice Address - Phone:248-967-6604
Practice Address - Fax:248-967-6506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MI53010037833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043167OtherPK
MI1887996Medicaid