Provider Demographics
NPI:1639567605
Name:WELLNESSRX PHARMACY CORPORATION
Entity type:Organization
Organization Name:WELLNESSRX PHARMACY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHUONG-NGA
Authorized Official - Middle Name:THI
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM,D
Authorized Official - Phone:858-682-3704
Mailing Address - Street 1:5971 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6335
Mailing Address - Country:US
Mailing Address - Phone:619-582-1933
Mailing Address - Fax:619-582-1936
Practice Address - Street 1:5971 UNIVERSITY AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6335
Practice Address - Country:US
Practice Address - Phone:619-582-1933
Practice Address - Fax:619-582-1936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy