Healthcare Provider Details

I. General information

NPI: 1043185952
Provider Name (Legal Business Name): RUTH LYN WELLS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W FOREST AVE
JACKSON TN
38301-3904
US

IV. Provider business mailing address

20 THORNWOOD CV
JACKSON TN
38305-6465
US

V. Phone/Fax

Practice location:
  • Phone: 731-541-1495
  • Fax:
Mailing address:
  • Phone: 901-674-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number10084
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: