Healthcare Provider Details

I. General information

NPI: 1497932628
Provider Name (Legal Business Name): CAROL PAULINE WELLS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 ACADEMY RD NE
ALBUQUERQUE NM
87111-1159
US

IV. Provider business mailing address

54 PLAZA DE LA NOCHE NE
ALBUQUERQUE NM
87109-3634
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-4480
  • Fax: 505-823-6693
Mailing address:
  • Phone: 505-821-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00004571
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: