Provider Demographics
NPI:1700245289
Name:THE WELLNESS CORNER, LLC
Entity Type:Organization
Organization Name:THE WELLNESS CORNER, LLC
Other - Org Name:THE WELLNESS CORNER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MAX
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-677-0120
Mailing Address - Street 1:17733 OLD JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3934
Mailing Address - Country:US
Mailing Address - Phone:225-677-8200
Mailing Address - Fax:225-677-8201
Practice Address - Street 1:17733 OLD JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3934
Practice Address - Country:US
Practice Address - Phone:225-677-8200
Practice Address - Fax:225-677-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHNR000397333600000X
TX290943336M0002X
NC126703336M0002X
LAPHY.006397-IR3336M0002X
AL1146243336M0002X
VA2140020063336M0002X
IA48813336M0002X
IN64002439A3336M0002X
OHNRP.022798750-033336M0002X
WAPHNR.FO.607986743336M0002X
IL054.0206083336M0002X
WI2041-433336M0002X
TN61213336M0002X
KYLA23513336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158047OtherPK
5416010001Medicare NSC