Organization Active NPI

Wellness Pharmacy of St Augustine LLC

  • Community/Retail Pharmacy
  • St Augustine, FL
National Provider Identifier
1902202898
Registry record updated Nov 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PH26918 Issued in FL
Legal business name
WELLNESS PHARMACY OF ST AUGUSTINE LLC
Doing business as
Wellness Pharmacy of St Augustine
Practice address
4405 Sartillo Rd
Suite B
St Augustine, FL 32095-5240
Phone
(904) 429-7333
Fax
(904) 460-2695
NPI assigned
Nov 5, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2014

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

Authorized official

Name
Dino Ajloni, PHARMD
Title
Pharmacist
Phone
(904) 429-7333

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PH26918 FL Primary

Addresses

Primary practice location

4405 Sartillo Rd
Suite B
St Augustine, FL 32095-5240

Mailing address

4405 Sartillo Rd
Suite B
St Augustine, FL 32095-5240
Phone (904) 429-7333

Other identifiers 3

IdentifierTypeStateIssuer
009136100MedicaidFL
5715252OtherNABP
PH26918OtherFLFLORIDA BOARD OF PHARMACY LICENSE NUMBER

Other names 1

  • Wellness Pharmacy of St Augustine Doing business as

National Provider Directory

National Provider Directory

Locations

4405 Sartillo Rd
Ste B
St Augustine, FL 32095
Phone (904) 429-7333

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1415145600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1415145600000",
    "number": "1902202898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 SARTILLO RD",
            "address_2": "SUITE B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320955240",
            "telephone_number": "904-429-7333",
            "fax_number": "904-460-2695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 SARTILLO RD",
            "address_2": "SUITE B",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320955240",
            "telephone_number": "904-429-7333",
            "fax_number": "904-460-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS PHARMACY OF ST AUGUSTINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-05",
        "last_updated": "2014-11-05",
        "status": "A",
        "authorized_official_last_name": "AJLONI",
        "authorized_official_first_name": "DINO",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "904-429-7333",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH26918",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009136100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "5715252",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BOARD OF PHARMACY LICENSE NUMBER",
            "identifier": "PH26918",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Pharmacy of St Augustine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2014; 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.