Provider Demographics
NPI:1548395718
Name:WELLS, ROGER D
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:D
Last Name:WELLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 RHODA ST.
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-4926
Mailing Address - Country:US
Mailing Address - Phone:828-648-6260
Mailing Address - Fax:
Practice Address - Street 1:630 CHAMPION DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-3032
Practice Address - Country:US
Practice Address - Phone:828-235-2795
Practice Address - Fax:828-235-8276
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC06964183500000X
GARPH010905183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist