PSR Wellness LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHY40633 Issued in CA

Legal business name

PSR WELLNESS LLC

Practice address

1390 Railroad Ave
Saint Helena, CA 94574-1124

Phone

(707) 963-2794

Fax

(707) 963-1954

NPI assigned

Jan 4, 2007

Organization subpart

Yes

Parent organization

PSR WELLNESS LLCAs reported in NPPES

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

Authorized official

Name

Mr. Pratap Krishna Anne

Title

Manager

Phone

(209) 298-1715

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 2

• SMITH'S ST. HELENA PHARMACY Doing business as
• SMITHS ST HELENA PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• PSR Wellness LLC

  • Community/Retail Pharmacy
  • Calistoga, CA
  • NPI 1700946936

  O20250214003372

  Same enrollment

Tax ID family

PSR Wellness LLC3 organizations share this tax ID, including this one

Part of

PSR Wellness LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• PSR Wellness LLC

  • Long Term Care Pharmacy
  • Saint Helena, CA
  • NPI 1144146010
  NPD tax ID
• PSR Wellness LLC

  • Community/Retail Pharmacy
  • Calistoga, CA
  • NPI 1700946936
  NPD tax ID

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737072000000",
    "number": "1356498406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1390 RAILROAD AVE",
            "city": "SAINT HELENA",
            "state": "CA",
            "postal_code": "945741124",
            "telephone_number": "707-963-2794",
            "fax_number": "707-963-1954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1390 RAILROAD AVE",
            "city": "SAINT HELENA",
            "state": "CA",
            "postal_code": "945741124",
            "telephone_number": "707-963-2794",
            "fax_number": "707-963-1954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSR WELLNESS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PSR WELLNESS LLC",
        "enumeration_date": "2007-01-04",
        "last_updated": "2025-01-17",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "ANNE",
        "authorized_official_first_name": "PRATAP",
        "authorized_official_middle_name": "KRISHNA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "209-298-1715",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY40633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356498406",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "1993716",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA406330",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMITH'S ST. HELENA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SMITHS ST HELENA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Aurina Gek Hong Poh Matacio, DDS
• Mark K. Potter, MD
• Steven R. Priebe, PH.D.
• Rhonda Marie Provost, CRNA
• PSR Wellness LLC
• Darrell B. Quirici, D.D.S.
• David R Racker, M.D.
• Analis Ramirez
• Pedro Javier Ramirez, M.D.
• Randy P. Hausted M.D. Inc

• Community/Retail Pharmacy in Saint Helena, CA
• Providers in Saint Helena, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; 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.