Provider Demographics
NPI:1043070790
Name:WELLS PHARMACY INC
Entity Type:Organization
Organization Name:WELLS PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-325-2671
Mailing Address - Street 1:PO BOX 346
Mailing Address - Street 2:
Mailing Address - City:NEODESHA
Mailing Address - State:KS
Mailing Address - Zip Code:66757-0346
Mailing Address - Country:US
Mailing Address - Phone:620-325-2671
Mailing Address - Fax:620-325-3326
Practice Address - Street 1:506 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEODESHA
Practice Address - State:KS
Practice Address - Zip Code:66757-1739
Practice Address - Country:US
Practice Address - Phone:620-325-2671
Practice Address - Fax:620-325-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003879970002Medicaid