Provider Demographics
NPI:1952300774
Name:WELLNESS FIRST PHARMACY
Entity Type:Organization
Organization Name:WELLNESS FIRST PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALTOM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:859-239-1721
Mailing Address - Street 1:217 SOUTH THIRD STREET
Mailing Address - Street 2:DEPT OF PHARMACY
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8911
Mailing Address - Country:US
Mailing Address - Phone:859-936-7219
Mailing Address - Fax:859-936-7220
Practice Address - Street 1:1107 BEN ALI DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8911
Practice Address - Country:US
Practice Address - Phone:859-936-7219
Practice Address - Fax:859-936-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty