Healthcare Provider Details

I. General information

NPI: 1770490005
Provider Name (Legal Business Name): BRANDON MICHAEL WELLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 E BASELINE RD
PHOENIX AZ
85042-7004
US

IV. Provider business mailing address

18350 N 32ND ST UNIT 173
PHOENIX AZ
85032-1236
US

V. Phone/Fax

Practice location:
  • Phone: 602-232-2982
  • Fax:
Mailing address:
  • Phone: 602-232-2982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS028067
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: