Healthcare Provider Details

I. General information

NPI: 1831735455
Provider Name (Legal Business Name): WELLS BROS. PHARMACY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E FRANKLIN ST
BLOOMFIELD IA
52537-1685
US

IV. Provider business mailing address

208 E FRANKLIN ST
BLOOMFIELD IA
52537-1685
US

V. Phone/Fax

Practice location:
  • Phone: 641-664-3100
  • Fax: 641-664-2290
Mailing address:
  • Phone: 641-664-3100
  • Fax: 641-664-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0223048
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name: MYLO E WELLS
Title or Position: OWNER
Credential: PHARMD
Phone: 641-664-3100