Provider Demographics
NPI:1518555143
Name:WELLS, DAVID D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
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 1:305 W OGEECHEE ST
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30467-1985
Mailing Address - Country:US
Mailing Address - Phone:912-564-2668
Mailing Address - Fax:
Practice Address - Street 1:305 W OGEECHEE ST
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:GA
Practice Address - Zip Code:30467-1985
Practice Address - Country:US
Practice Address - Phone:912-564-2668
Practice Address - Fax:912-564-1189
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist