Provider Demographics
NPI:1831735455
Name:WELLS BROS. PHARMACY SERVICES, LLC
Entity type:Organization
Organization Name:WELLS BROS. PHARMACY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYLO
Authorized Official - Middle Name:E
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:641-664-3100
Mailing Address - Street 1:208 E FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1685
Mailing Address - Country:US
Mailing Address - Phone:641-664-3100
Mailing Address - Fax:641-664-2290
Practice Address - Street 1:208 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1685
Practice Address - Country:US
Practice Address - Phone:641-664-3100
Practice Address - Fax:641-664-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223048Medicaid