Provider Demographics
NPI:1881973519
Name:WELLNESS PHARMACY LLC
Entity type:Organization
Organization Name:WELLNESS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:AGATHA
Authorized Official - Last Name:OBI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:713-494-5262
Mailing Address - Street 1:1480 WILCREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2229
Mailing Address - Country:US
Mailing Address - Phone:713-532-0008
Mailing Address - Fax:713-532-0020
Practice Address - Street 1:1480 WILCREST DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2229
Practice Address - Country:US
Practice Address - Phone:713-532-0008
Practice Address - Fax:713-532-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27586183500000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146456Medicaid