Provider Demographics
NPI:1831195015
Name:WELLMAN, JOHN B I
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:B
Last Name:WELLMAN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 PYLE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45113-9344
Mailing Address - Country:US
Mailing Address - Phone:937-783-5444
Mailing Address - Fax:937-783-5446
Practice Address - Street 1:912 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BLANCHESTER
Practice Address - State:OH
Practice Address - Zip Code:45107-1318
Practice Address - Country:US
Practice Address - Phone:937-783-5444
Practice Address - Fax:937-783-5446
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-22486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist