Provider Demographics
NPI:1104869981
Name:THE WELLNESS CORNER, LLC
Entity type:Organization
Organization Name:THE WELLNESS CORNER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:225-677-8200
Mailing Address - Street 1:17733 OLD JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3934
Mailing Address - Country:US
Mailing Address - Phone:225-677-8200
Mailing Address - Fax:225-677-8201
Practice Address - Street 1:17733 OLD JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3934
Practice Address - Country:US
Practice Address - Phone:225-677-8200
Practice Address - Fax:225-677-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH31188333600000X
IL054.0206083336C0003X
TX290943336C0003X
OHNRP.022798750-033336C0003X
LAPHY.006397-IR3336C0003X
KYLA23513336C0003X
WAPHNR.FO.607986743336C0003X
IN64002439A3336C0003X
WI2041-433336C0003X
NC126703336C0003X
TN61213336C0003X
VA02140020063336C0003X
GAPHNR0003973336C0004X
IA48813336H0001X
AL1146243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2035271OtherPK
5416010001Medicare NSC
5416010001Medicare NSC