Provider Demographics
NPI:1538299748
Name:WELLS, JEWELEAN S (RPH)
Entity Type:Individual
Prefix:
First Name:JEWELEAN
Middle Name:S
Last Name:WELLS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:S
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1740 EDDIE ROBINSON SR DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70802-5017
Mailing Address - Country:US
Mailing Address - Phone:225-336-9924
Mailing Address - Fax:225-757-6038
Practice Address - Street 1:5005 CHURCH ST
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-3511
Practice Address - Country:US
Practice Address - Phone:225-654-6388
Practice Address - Fax:225-654-9418
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist