Provider Demographics
NPI:1538409545
Name:WELLNESS 1 PHARMACY LLC
Entity type:Organization
Organization Name:WELLNESS 1 PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:FATHI
Authorized Official - Last Name:YAHYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-515-9366
Mailing Address - Street 1:2420 S.SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-7635
Mailing Address - Country:US
Mailing Address - Phone:937-256-4000
Mailing Address - Fax:
Practice Address - Street 1:2420 S SMITHVILLE RD
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-1458
Practice Address - Country:US
Practice Address - Phone:513-515-9366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7110550001Medicare NSC