Healthcare Provider Details

I. General information

NPI: 1659317147
Provider Name (Legal Business Name): WELLS PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1984 INDIAN HILL BLVD
POMONA CA
91767-3620
US

IV. Provider business mailing address

PO BOX 1207
UPLAND CA
91785-1207
US

V. Phone/Fax

Practice location:
  • Phone: 909-949-6889
  • Fax: 909-949-2188
Mailing address:
  • Phone: 909-949-6889
  • Fax: 909-949-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY54450
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YI YI SUN
Title or Position: PRESIDENT
Credential:
Phone: 909-949-6889