Provider Demographics
NPI:1932421963
Name:WELLS, DOUGLAS MAURICE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MAURICE
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 1:11260 PLEASANT VALLEY RD
Mailing Address - Street 2:PLEASANT VALLEY PHARMACY
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9413
Mailing Address - Country:US
Mailing Address - Phone:530-432-3921
Mailing Address - Fax:
Practice Address - Street 1:11260 PLEASANT VALLEY RD
Practice Address - Street 2:PLEASANT VALLEY PHARMACY
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-9413
Practice Address - Country:US
Practice Address - Phone:530-432-3921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH35318183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARPH35318OtherSTATE PHARMACIST LICENSE NUMBER