Provider Demographics
NPI:1578331575
Name:WELLS ROAD PHARMACY LLC
Entity Type:Organization
Organization Name:WELLS ROAD PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AJLONI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:954-818-0739
Mailing Address - Street 1:1635 WELLS RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2303
Mailing Address - Country:US
Mailing Address - Phone:954-818-0739
Mailing Address - Fax:
Practice Address - Street 1:1635 WELLS RD STE 3
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2303
Practice Address - Country:US
Practice Address - Phone:954-818-0739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty