Provider Demographics
NPI:1780126771
Name:WELLCARE HEALTHCARE PHARMACY INC
Entity type:Organization
Organization Name:WELLCARE HEALTHCARE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BADAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SATASIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-299-7100
Mailing Address - Street 1:9493 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3765
Mailing Address - Country:US
Mailing Address - Phone:951-299-7100
Mailing Address - Fax:951-299-7959
Practice Address - Street 1:9493 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3765
Practice Address - Country:US
Practice Address - Phone:951-299-7100
Practice Address - Fax:951-299-7959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54630333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy