Provider Demographics
NPI:1699467431
Name:WELLPORT MEDICINE INC
Entity type:Organization
Organization Name:WELLPORT MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAFIZ
Authorized Official - Middle Name:MUHAMMAD
Authorized Official - Last Name:USMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-637-2148
Mailing Address - Street 1:2515 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-296-9297
Mailing Address - Fax:203-296-9298
Practice Address - Street 1:2515 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-296-9297
Practice Address - Fax:203-296-9298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy