Provider Demographics
NPI:1215473939
Name:MISSION WELLNESS HEALTHCARE LLC
Entity type:Organization
Organization Name:MISSION WELLNESS HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRZEJEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-577-4743
Mailing Address - Street 1:PO 7775 #52191
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94120
Mailing Address - Country:US
Mailing Address - Phone:415-577-4743
Mailing Address - Fax:
Practice Address - Street 1:350 PARNASSUS AVE STE 505
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3628
Practice Address - Country:US
Practice Address - Phone:415-926-6270
Practice Address - Fax:415-826-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55442333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2167370OtherPK