Organization
OPTIMUM WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW SAMMONS (OWNER)
(606) 220-2553
Entity
Organization
Contact information
Practice address
716 BROADWAY ST, PAINTSVILLE, KY 41240-1357
(606) 792-2330
Mailing address
716 BROADWAY ST, PAINTSVILLE, KY 41240-1357
(606) 220-2553
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100648130
—
KY
Enumeration date
01/17/2020
Last updated
06/20/2020
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