Provider Demographics
NPI:1033667530
Name:WELLS, MICHAEL (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MT
Mailing Address - Zip Code:59935-0328
Mailing Address - Country:US
Mailing Address - Phone:406-295-4361
Mailing Address - Fax:406-295-5326
Practice Address - Street 1:611 EAST MISSOULA AVE.
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MT
Practice Address - Zip Code:59935
Practice Address - Country:US
Practice Address - Phone:406-295-4361
Practice Address - Fax:406-295-5326
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist