Provider Demographics
NPI:1669755724
Name:WELLS, RONALD DALE (RPH)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DALE
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 1:11430 FLORIDA BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-2403
Mailing Address - Country:US
Mailing Address - Phone:225-275-3076
Mailing Address - Fax:225-275-9318
Practice Address - Street 1:11430 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2403
Practice Address - Country:US
Practice Address - Phone:225-275-3076
Practice Address - Fax:225-275-9318
Is Sole Proprietor?:No
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist