Provider Demographics
NPI:1841991130
Name:WELLMART PHARMACY INC.
Entity type:Organization
Organization Name:WELLMART PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:OKEBIORUN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:215-427-1603
Mailing Address - Street 1:2363 E ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4466
Mailing Address - Country:US
Mailing Address - Phone:215-427-1603
Mailing Address - Fax:215-427-3590
Practice Address - Street 1:2363 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4466
Practice Address - Country:US
Practice Address - Phone:215-427-1603
Practice Address - Fax:215-427-3590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLMART PHARMACY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy