Provider Demographics
NPI:1740006808
Name:WELLSPRING PHARMACY
Entity type:Organization
Organization Name:WELLSPRING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIER
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-480-5311
Mailing Address - Street 1:11398 BANDERA RD STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6843
Mailing Address - Country:US
Mailing Address - Phone:713-480-5311
Mailing Address - Fax:
Practice Address - Street 1:11398 BANDERA RD STE 302
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6843
Practice Address - Country:US
Practice Address - Phone:713-480-5311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy