Healthcare Provider Details

I. General information

NPI: 1407486814
Provider Name (Legal Business Name): SASHA WELLS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 01/24/2020
Certification Date: 01/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E NORTH ST
ELDON MO
65026-1749
US

IV. Provider business mailing address

PO BOX 20
ELDON MO
65026-0020
US

V. Phone/Fax

Practice location:
  • Phone: 573-392-7336
  • Fax:
Mailing address:
  • Phone: 573-480-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number2000172877
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: