Provider Demographics
NPI:1760593826
Name:WELLS AMERICAN, INC.
Entity Type:Organization
Organization Name:WELLS AMERICAN, INC.
Other - Org Name:PROMED PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-444-5027
Mailing Address - Street 1:2421 ALDINE MAIL RT SUITE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039
Mailing Address - Country:US
Mailing Address - Phone:281-372-8522
Mailing Address - Fax:281-372-8524
Practice Address - Street 1:2421 ALDINE MAIL RT SUITE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77039
Practice Address - Country:US
Practice Address - Phone:281-372-8522
Practice Address - Fax:281-372-8524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145359Medicaid
TX145359Medicaid