Provider Demographics
NPI:1316538275
Name:WELLS, CLAYTON P (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:P
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 395
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-0395
Mailing Address - Country:US
Mailing Address - Phone:606-298-2080
Mailing Address - Fax:
Practice Address - Street 1:94 BOARDWALK
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-7003
Practice Address - Country:US
Practice Address - Phone:606-298-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012174183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist