NPIMap

Organization Active NPI

Wellcare Pharmacy Inc

  • Pharmacist
  • Owings Mills, MD
National Provider Identifier
1225127152
Registry record updated Mar 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
P04406 Issued in MD
Legal business name
WELLCARE PHARMACY INC
Practice address
9213 Lakeside Blvd
Owings Mills, MD 21117-3859
Phone
(410) 654-4441
Fax
(410) 654-4463
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2008

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

Authorized official

Name
Dr. Temitope Oulwayemisi Gbolagun
Title
Owner / President/Pharmacy MGR
Phone
(410) 654-4441

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PharmacistGroup: 193400000X SINGLE SPECIALTY GROUP 183500000X P04406 MD Primary

Addresses

Primary practice location

9213 Lakeside Blvd
Owings Mills, MD 21117-3859

Mailing address

9213 Lakeside Blvd
Owings Mills, MD 21117-3859
Phone (410) 654-4441

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081112000443 MD Part B Supplier - Mass Immunization (Roster Biller Only) 9234298753 Practice locations: Owings Mills, MD

National Provider Directory

National Provider Directory

Locations

9213 Lakeside Blvd
Owings Mills, MD 21117
Phone (410) 654-4441

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205280000000",
    "number": "1225127152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9213 LAKESIDE BLVD",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173859",
            "telephone_number": "410-654-4441",
            "fax_number": "410-654-4463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9213 LAKESIDE BLVD",
            "city": "OWINGS MILLS",
            "state": "MD",
            "postal_code": "211173859",
            "telephone_number": "410-654-4441",
            "fax_number": "410-654-4463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLCARE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2008-03-12",
        "status": "A",
        "authorized_official_last_name": "GBOLAGUN",
        "authorized_official_first_name": "TEMITOPE",
        "authorized_official_middle_name": "OULWAYEMISI",
        "authorized_official_title_or_position": "OWNER /  PRESIDENT/PHARMACY MGR",
        "authorized_official_telephone_number": "410-654-4441",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "MD",
            "license": "P04406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owings Mills, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.