Provider Demographics
NPI:1538580535
Name:WELLMART PHARMACY INC
Entity type:Organization
Organization Name:WELLMART PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-935-9690
Mailing Address - Street 1:403 W GRAND PKWY S STE S
Mailing Address - Street 2:STE E
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-8358
Mailing Address - Country:US
Mailing Address - Phone:281-208-7138
Mailing Address - Fax:
Practice Address - Street 1:403 W GRAND PKWY S STE S
Practice Address - Street 2:STE E
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8358
Practice Address - Country:US
Practice Address - Phone:281-208-7138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy