Provider Demographics
NPI:1972045813
Name:WELLNESS 1 PHARMACY-WEST
Entity Type:Organization
Organization Name:WELLNESS 1 PHARMACY-WEST
Other - Org Name:WELLNESS1PHARMACY-WEST CARROLLTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PIC/AO
Authorized Official - Prefix:
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAHYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-515-9366
Mailing Address - Street 1:2092 S ALEX RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-2491
Mailing Address - Country:US
Mailing Address - Phone:937-384-7777
Mailing Address - Fax:937-384-7778
Practice Address - Street 1:2092 S ALEX RD
Practice Address - Street 2:SUITE A
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-2491
Practice Address - Country:US
Practice Address - Phone:937-384-7777
Practice Address - Fax:937-384-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OH022653350-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166240OtherPK
OH0193686Medicaid