Provider Demographics
NPI:1740268549
Name:WELLS PHARMACY NETWORK LLC
Entity type:Organization
Organization Name:WELLS PHARMACY NETWORK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS AND BU
Authorized Official - Prefix:
Authorized Official - First Name:DARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-793-1568
Mailing Address - Street 1:1210 SW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-2853
Mailing Address - Country:US
Mailing Address - Phone:352-622-2913
Mailing Address - Fax:352-401-5650
Practice Address - Street 1:1210 SW 33RD AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-2853
Practice Address - Country:US
Practice Address - Phone:352-622-2913
Practice Address - Fax:352-401-5650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH262493336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1002752OtherNCPDP PROVIDER IDENTIFICATION NUMBER