Provider Demographics
NPI:1962257683
Name:WELLWISE PHARMACY INC.
Entity type:Organization
Organization Name:WELLWISE PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMITRIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:ONUAGULUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:347-209-6409
Mailing Address - Street 1:5522 DRYAD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-4330
Mailing Address - Country:US
Mailing Address - Phone:281-762-1809
Mailing Address - Fax:281-238-5784
Practice Address - Street 1:2519 N FRAZIER ST STE 3200
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303-1683
Practice Address - Country:US
Practice Address - Phone:281-762-1809
Practice Address - Fax:281-238-5784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy