Healthcare Provider Details

I. General information

NPI: 1962004549
Provider Name (Legal Business Name): AMY LUANNE WELLS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 BURGESS RD
HARRISONBURG VA
22801-3704
US

IV. Provider business mailing address

33 BIRDALE DR
WEYERS CAVE VA
24486-2470
US

V. Phone/Fax

Practice location:
  • Phone: 540-433-1106
  • Fax:
Mailing address:
  • Phone: 540-810-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202011147
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: