Organization
WELLNESS PHARMACY INC
Active
Other names
WELLNESS PHARMACY inc
Organization subpart
No
Provider details
NPI number
Authorized official
GASHAW ADANE BPHARM (OWNER/PIC/AO)
(813) 408-4097
Entity
Organization
Contact information
Practice address
120 W BOUGAINVILLEA AVE, TAMPA, FL 33612-7437
(813) 774-8856
(813) 319-3760
Mailing address
120 W BOUGAINVILLEA AVE, TAMPA, FL 33612-7437
(813) 774-8856
(813) 319-3760
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH24665
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002872100
—
FL
01
—
2126001
PK
—
Enumeration date
08/05/2010
Last updated
07/19/2018
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