Provider Demographics
NPI:1154805422
Name:WELLNESSSCRIPTRX
Entity type:Organization
Organization Name:WELLNESSSCRIPTRX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMPOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:414-409-8195
Mailing Address - Street 1:159 N JACKSON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6169
Mailing Address - Country:US
Mailing Address - Phone:414-409-8195
Mailing Address - Fax:
Practice Address - Street 1:159 N JACKSON ST STE 105
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6169
Practice Address - Country:US
Practice Address - Phone:855-988-4900
Practice Address - Fax:855-998-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy