Provider Demographics
NPI:1710690656
Name:WELLSPRING PHARMACY HEALTH INC.
Entity Type:Organization
Organization Name:WELLSPRING PHARMACY HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:419-961-2593
Mailing Address - Street 1:1987 W 4TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1708
Mailing Address - Country:US
Mailing Address - Phone:419-756-2559
Mailing Address - Fax:
Practice Address - Street 1:1987 W 4TH ST STE 200
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1708
Practice Address - Country:US
Practice Address - Phone:419-756-2559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy