Provider Demographics
NPI:1811359136
Name:WELLNESS PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:WELLNESS PHARMACY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAYLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-277-7132
Mailing Address - Street 1:1427 HORSHAM RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1320
Mailing Address - Country:US
Mailing Address - Phone:215-277-7132
Mailing Address - Fax:215-277-7135
Practice Address - Street 1:1427 HORSHAM ROAD
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454
Practice Address - Country:US
Practice Address - Phone:215-277-7132
Practice Address - Fax:215-277-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QI0500X, 3336S0011X, 333600000X, 3336H0001X
PAPP4824243336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2158988OtherPK
PA102863688-0001Medicaid
2158988OtherPK