# WELLMART RX, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023488681
- **Authorized official:** SIMON DAVYDOV (PRESIDENT)
- **Authorized official phone:** (718) 704-0808

## Contact information

- **Practice address:** 21913 JAMAICA AVE, QUEENS VILLAGE, NY 11428-2126
- **Practice address phone:** (718) 704-0808
- **Practice address fax:** (718) 704-0818
- **Mailing address:** 21913 JAMAICA AVE, QUEENS VILLAGE, NY 11428-2126
- **Mailing address phone:** (718) 704-0808
- **Mailing address fax:** (718) 704-0818

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/25/2015
- **Last updated:** 09/20/2016