Organization Active NPI

Wellness Pharmacy, Inc

  • Community/Retail Pharmacy
  • Lincoln, NE
National Provider Identifier
1902252521
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
3100 Issued in NE
Legal business name
WELLNESS PHARMACY, INC
Practice address
4640 Champlain Dr
113
Lincoln, NE 68521-4714
Phone
(402) 413-9950
Fax
(402) 413-9964
NPI assigned
May 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Authorized official

Name
Kayla A PhamNPI 1326324393
Title
President/Ceo
Phone
(402) 304-7564

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 3100 NE Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

4640 Champlain Dr
113
Lincoln, NE 68521-4714

Mailing address

4640 Champlain Dr Ste 113
Lincoln, NE 68521-4714
Phone (402) 413-9950

Other identifiers 1

IdentifierTypeStateIssuer
10026581700MedicaidNE

Other names 1

  • Specialty Compounding Pharmacy Former legal business name

National Provider Directory

National Provider Directory

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": "1463011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765411200000",
    "number": "1902252521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4640 CHAMPLAIN DR STE 113",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685214714",
            "telephone_number": "402-413-9950",
            "fax_number": "402-413-9964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4640 CHAMPLAIN DR",
            "address_2": "113",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685214714",
            "telephone_number": "402-413-9950",
            "fax_number": "402-413-9964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS PHARMACY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-12",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "KAYLA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "402-304-7564"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NE",
            "license": "3100",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026581700",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Specialty Compounding Pharmacy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lincoln, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2025; 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.