Wellness Store Compounding Pharmacy

LBN: Robin Godfrey Terrero
Wellness Store Compounding Pharmacy is an health care organization with primary practice located at 3555 Keith St Nw Ste 210 , Cleveland TN 37312-4375. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Community/Retail Pharmacy, Suppliers / Compounding Pharmacy. Suppliers / Pharmacy is the primary health care specialty. Robin Godfrey Terrero can be contacted via phone (423) 476-4312, or through Terrero, Robin via phone (423) 476-4312.

Contact Information

Primary practice address
3555 Keith St Nw Ste 210 Cleveland TN 37312-4375
Phone: (423) 476-4312
Fax: (423) 476-7982
Website:
Map and Directions
Authorized official contact:
Name: Terrero, Robin RPH
Phone: (423) 476-4312

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X 3223 Tennessee
Suppliers / Community/Retail Pharmacy 3336C0003X
Suppliers / Compounding Pharmacy 3336C0004X

Profile Details

NPI number 1518941392
LBN Legal business name Robin Godfrey Terrero
DBA Doing business as Wellness Store Compounding Pharmacy
Authorized official Terrero, Robin RPH
Entity Organization
Organization subpart 1 No
Enumeration date Dec 5th, 2005
Last updated Apr 3rd, 2013 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518941392 NPPES
Other 2092295 PK
MEDICAID 1452909 PK

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