Organization
WELLMART PHARMACY INC.
Active
Other names
La Vida Discount Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD OKEBIORUN RPH (PRESIDENT)
(215) 427-1603
Entity
Organization
Contact information
Practice address
2363 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-4431
(215) 427-1603
(215) 427-3590
Mailing address
2363 E ALLEGHENY AVE, PHILADELPHIA, PA 19134-4431
(215) 427-1603
(215) 427-3590
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
PP482534
PA
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103543558
—
PA
Enumeration date
08/30/2018
Last updated
12/20/2021
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