Provider Demographics
NPI:1831509934
Name:WELLCARE PHARMACY
Entity type:Organization
Organization Name:WELLCARE PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REDIET
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:202-262-9328
Mailing Address - Street 1:3923 S CAPITOL ST SW
Mailing Address - Street 2:UNIT A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2308
Mailing Address - Country:US
Mailing Address - Phone:202-847-0237
Mailing Address - Fax:
Practice Address - Street 1:3923 S CAPITOL ST SW
Practice Address - Street 2:UNIT A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2308
Practice Address - Country:US
Practice Address - Phone:202-847-0237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRX00000583336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy