Provider Demographics
NPI:1366208548
Name:ABUNDANT WELLNESS INC
Entity type:Organization
Organization Name:ABUNDANT WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-533-4019
Mailing Address - Street 1:301 N PEPPER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1839
Mailing Address - Country:US
Mailing Address - Phone:909-533-4019
Mailing Address - Fax:909-533-4019
Practice Address - Street 1:301 N PEPPER AVE STE 300
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1839
Practice Address - Country:US
Practice Address - Phone:909-533-4019
Practice Address - Fax:909-533-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy