Provider Demographics
NPI:1902681281
Name:WELLNESS MED SUPPLIES LLC
Entity Type:Organization
Organization Name:WELLNESS MED SUPPLIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRUKH
Authorized Official - Middle Name:S
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:800-680-3963
Mailing Address - Street 1:2020 N ACADEMY BLVD STE 265
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1567
Mailing Address - Country:US
Mailing Address - Phone:800-680-3963
Mailing Address - Fax:800-680-3963
Practice Address - Street 1:2020 N ACADEMY BLVD STE 265
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1567
Practice Address - Country:US
Practice Address - Phone:800-680-3963
Practice Address - Fax:800-680-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-25
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies