Provider Demographics
NPI:1497883771
Name:WELLS, ANNAH SHEARIN (RPH)
Entity Type:Individual
Prefix:
First Name:ANNAH
Middle Name:SHEARIN
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 1:209 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-1508
Mailing Address - Country:US
Mailing Address - Phone:919-894-4651
Mailing Address - Fax:919-894-7498
Practice Address - Street 1:209 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-1508
Practice Address - Country:US
Practice Address - Phone:919-894-4651
Practice Address - Fax:919-894-7498
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9244OtherPHARMACY LICENSE