Provider Demographics
NPI:1720852858
Name:KABILA WELLNESS. LLC
Entity Type:Organization
Organization Name:KABILA WELLNESS. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASTON
Authorized Official - Middle Name:O
Authorized Official - Last Name:BRISSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-447-0088
Mailing Address - Street 1:4 CORPORATE DR STE 392
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6241
Mailing Address - Country:US
Mailing Address - Phone:203-447-0088
Mailing Address - Fax:203-552-2194
Practice Address - Street 1:4 CORPORATE DR STE 392
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6241
Practice Address - Country:US
Practice Address - Phone:203-447-0088
Practice Address - Fax:203-552-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy