Indiana Wellness RX LLC

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

INDIANA WELLNESS RX LLC

Practice address

215 W 4TH St Ste 1
Mishawaka, IN 46544-1917

Phone

(574) 544-0102

NPI assigned

Feb 2, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kirill Vesselov

Title

Owner

Phone

(930) 888-3990

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689033600000",
    "number": "1184215105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 W 4TH ST STE 1",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441917",
            "telephone_number": "574-544-0102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 W 4TH ST STE 1",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465441917",
            "telephone_number": "574-544-0102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA WELLNESS RX LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-02",
        "last_updated": "2023-07-11",
        "certification_date": "2023-07-11",
        "status": "A",
        "authorized_official_last_name": "VESSELOV",
        "authorized_official_first_name": "KIRILL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "930-888-3990"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pharmacy in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.