Provider Demographics
NPI:1417737206
Name:WELLS, TATYANA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9208 GRAHAM RIDGE DR APT 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-5571
Mailing Address - Country:US
Mailing Address - Phone:803-600-3296
Mailing Address - Fax:
Practice Address - Street 1:1310 S CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6233
Practice Address - Country:US
Practice Address - Phone:704-938-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC44141183500000X
NC32666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist