Provider Demographics
NPI:1730273145
Name:WELLS PHARMACY SERVICES INC
Entity type:Organization
Organization Name:WELLS PHARMACY SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:912-564-2720
Mailing Address - Street 1:331 MIMS RD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-1992
Mailing Address - Country:US
Mailing Address - Phone:912-564-2720
Mailing Address - Fax:912-564-2717
Practice Address - Street 1:331 MIMS RD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-1992
Practice Address - Country:US
Practice Address - Phone:912-564-2720
Practice Address - Fax:912-564-2717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8354333600000X
GAPHRE0083543336L0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00846381BMedicaid
1146504OtherOTHER ID NUMBER-COMMERCIAL NUMBER
GA00846381AMedicaid
GA00846381AMedicaid
GA1291510001Medicare NSC