Healthcare Provider Details

I. General information

NPI: 1154374320
Provider Name (Legal Business Name): PAULA WELLS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W CENTRAL AVE
MIAMI OK
74354-6815
US

IV. Provider business mailing address

129 E ST NW
MIAMI OK
74354-6120
US

V. Phone/Fax

Practice location:
  • Phone: 918-542-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13638
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: