Healthcare Provider Details

I. General information

NPI: 1104909639
Provider Name (Legal Business Name): WELLDYNE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7472 S TUCSON WAY SUITE 100-B
CENTENNIAL CO
80112-4452
US

IV. Provider business mailing address

7472 S TUCSON WAY SUITE 100-B
CENTENNIAL CO
80112-4452
US

V. Phone/Fax

Practice location:
  • Phone: 800-641-8475
  • Fax: 800-530-8589
Mailing address:
  • Phone: 800-641-8475
  • Fax: 800-530-8589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number370000059
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number370000059
License Number StateCO

VIII. Authorized Official

Name: SUSAN C. CAIN
Title or Position: COO
Credential:
Phone: 303-645-2613