Organization
FIDELIS HEALTH GROUP LLC
Active
Other names
Fidelis Specialty Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
WAGNER A LEMUS (PRESIDENT)
(702) 815-0800
Entity
Organization
Contact information
Practice address
1002 S BALDWIN AVE, ARCADIA, CA 91007-7234
(626) 447-2138
(626) 447-6433
Mailing address
1002 S BALDWIN AVE, ARCADIA, CA 91007-7234
(626) 447-2138
(626) 447-6433
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
PHY52510
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316135569
—
CA
01
—
2149274
PK
—
Enumeration date
10/11/2007
Last updated
09/20/2018
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