Provider Demographics
NPI:1417293325
Name:WELLHOFF, ANA MIRIAM (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANA MIRIAM
Middle Name:
Last Name:WELLHOFF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 PINE ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1207
Mailing Address - Country:US
Mailing Address - Phone:508-653-9298
Mailing Address - Fax:
Practice Address - Street 1:21 STANHOPE ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5111
Practice Address - Country:US
Practice Address - Phone:617-375-7969
Practice Address - Fax:617-375-9656
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH22246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA22246OtherPHARMACIST