Provider Demographics
NPI:1295249860
Name:CARSON WELLNESS PHARMACY INC
Entity type:Organization
Organization Name:CARSON WELLNESS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIDINMA
Authorized Official - Middle Name:JENNY
Authorized Official - Last Name:CHIKEZIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-422-6586
Mailing Address - Street 1:20111 WADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3046
Mailing Address - Country:US
Mailing Address - Phone:310-422-6586
Mailing Address - Fax:424-295-7999
Practice Address - Street 1:22005 AVALON BLVD STE D
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-7169
Practice Address - Country:US
Practice Address - Phone:424-295-7979
Practice Address - Fax:424-295-7999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55785333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy