Provider Demographics
NPI:1437137486
Name:WELLS, CONSTANCE CRANDALL (RPH)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:CRANDALL
Last Name:WELLS
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 1:22803 44TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5032
Mailing Address - Country:US
Mailing Address - Phone:425-771-3738
Mailing Address - Fax:
Practice Address - Street 1:22803 44TH AVE W
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5032
Practice Address - Country:US
Practice Address - Phone:425-771-3738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009797183500000X
CA29433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist