Healthcare Provider Details

I. General information

NPI: 1164980660
Provider Name (Legal Business Name): WELLS SPECIALTY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3796 HOWELL BRANCH RD
WINTER PARK FL
32792-1740
US

IV. Provider business mailing address

3796 HOWELL BRANCH RD
WINTER PARK FL
32792-1740
US

V. Phone/Fax

Practice location:
  • Phone: 407-671-8070
  • Fax: 407-671-7960
Mailing address:
  • Phone: 407-671-8070
  • Fax: 407-671-7960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN S SHAPIRO
Title or Position: PRESIDENT
Credential:
Phone: 844-442-9482