Provider Demographics
NPI:1609156686
Name:WELLS, MICHAEL KYLE (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KYLE
Last Name:WELLS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2920 S RANGE AVE
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-5566
Mailing Address - Country:US
Mailing Address - Phone:225-998-1800
Mailing Address - Fax:225-998-1803
Practice Address - Street 1:2920 S RANGE AVE
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5566
Practice Address - Country:US
Practice Address - Phone:225-998-1800
Practice Address - Fax:225-998-1803
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist