Healthcare Provider Details

I. General information

NPI: 1396054797
Provider Name (Legal Business Name): SVETLANA WELLS PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2010
Last Update Date: 10/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 BRIDGER DR
GREEN RIVER WY
82935-5879
US

IV. Provider business mailing address

10 LONG DR
ROCK SPRINGS WY
82901-3204
US

V. Phone/Fax

Practice location:
  • Phone: 307-875-7841
  • Fax:
Mailing address:
  • Phone: 307-389-4526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3220
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: