Provider Demographics
NPI:1609294677
Name:WELLS, JOHN J (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:WELLS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15474 W GREENWAY RD
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-4348
Mailing Address - Country:US
Mailing Address - Phone:623-584-1964
Mailing Address - Fax:623-544-2359
Practice Address - Street 1:15474 W GREENWAY RD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-4348
Practice Address - Country:US
Practice Address - Phone:623-584-1964
Practice Address - Fax:623-544-2359
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist