Organization
PCCW LLC
Active
Other names
Welltopia Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
OMAR ELIWA RPH (OWNER, RPH, AO)
(414) 204-4025
Entity
Organization
Contact information
Practice address
136 N MAIN ST, THIENSVILLE, WI 53092-1606
(414) 810-7229
(414) 433-1810
Mailing address
136 N MAIN ST, THIENSVILLE, WI 53092-1606
(414) 810-7229
(414) 433-1810
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9426-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167161
PK
—
Enumeration date
10/20/2016
Last updated
05/26/2022
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