Provider Demographics
NPI:1932281607
Name:WELLS, JERRY F (RPH)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:F
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 1:154 ROYSTER DR
Mailing Address - Street 2:SHELL PT. HARBOR
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-4626
Mailing Address - Country:US
Mailing Address - Phone:850-926-7275
Mailing Address - Fax:850-922-0156
Practice Address - Street 1:154 ROYSTER DR
Practice Address - Street 2:SHELL PT. HARBOR
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-4626
Practice Address - Country:US
Practice Address - Phone:850-926-7275
Practice Address - Fax:850-922-0156
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS107701835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy