Provider Demographics
NPI:1760087183
Name:FLETCHER, ALLEN WELLS
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:WELLS
Last Name:FLETCHER
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 1:689 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-2703
Mailing Address - Country:US
Mailing Address - Phone:508-238-0604
Mailing Address - Fax:
Practice Address - Street 1:689 DEPOT ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-2703
Practice Address - Country:US
Practice Address - Phone:508-238-0604
Practice Address - Fax:508-238-2718
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA08131977OtherRANDOM
08131977OtherPHARMACIST