Provider Demographics
NPI:1457393233
Name:WELLMING DRUG INC
Entity Type:Organization
Organization Name:WELLMING DRUG INC
Other - Org Name:WELLMING PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISING PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:YA-LING
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, MS
Authorized Official - Phone:718-321-3978
Mailing Address - Street 1:13343 41ST RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3787
Mailing Address - Country:US
Mailing Address - Phone:718-321-3978
Mailing Address - Fax:718-321-3976
Practice Address - Street 1:13343 41ST RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3787
Practice Address - Country:US
Practice Address - Phone:718-321-3978
Practice Address - Fax:718-321-3976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
NY0276003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02740572Medicaid
2067418OtherPK
NY02740572Medicaid