Provider Demographics
NPI:1487235768
Name:WELLCARE PHARMACY LLC
Entity type:Organization
Organization Name:WELLCARE PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEGANNATHAN
Authorized Official - Middle Name:RENGARAJAN
Authorized Official - Last Name:RENGARAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-668-8425
Mailing Address - Street 1:2445 MEMORIAL BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5156
Mailing Address - Country:US
Mailing Address - Phone:615-410-3499
Mailing Address - Fax:615-809-2025
Practice Address - Street 1:2445 MEMORIAL BLVD STE E
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-5156
Practice Address - Country:US
Practice Address - Phone:615-410-3499
Practice Address - Fax:615-809-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-18
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy