Provider Demographics
NPI:1700109428
Name:WELLS, PORTIA A (RPH)
Entity Type:Individual
Prefix:MS
First Name:PORTIA
Middle Name:A
Last Name:WELLS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-2714
Mailing Address - Country:US
Mailing Address - Phone:203-687-9291
Mailing Address - Fax:203-468-9795
Practice Address - Street 1:157 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-2525
Practice Address - Country:US
Practice Address - Phone:203-468-9732
Practice Address - Fax:203-468-9795
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.9370183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist