Provider Demographics
NPI:1205492667
Name:WELLS, MYLO E (PHARMD)
Entity type:Individual
Prefix:
First Name:MYLO
Middle Name:E
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 1:208 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1685
Mailing Address - Country:US
Mailing Address - Phone:641-664-3100
Mailing Address - Fax:641-664-2290
Practice Address - Street 1:208 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1685
Practice Address - Country:US
Practice Address - Phone:641-664-3100
Practice Address - Fax:641-664-2290
Is Sole Proprietor?:No
Enumeration Date:2019-05-11
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist