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General NPI Number Information
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NPI Number | 1255763751
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Entity Type | Organization
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Legal Business Name | WELLS DRUGS INC
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Dates
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Enumeration Date | 08/07/2013
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 2636 JACKSBORO PIKE
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City | JACKSBORO
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State | TN
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Zip | 37757-4848
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Country | US
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Telephone | 423-566-1967
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Fax | 423-566-1797
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Provider Business Mailing Address
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Address Line | PO BOX 100
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City | JACKSBORO
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State | TN
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Zip | 37757-0100
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Country | US
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Telephone | 423-566-1967
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Fax | 423-566-1797
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Authorized Official
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Title or Position | OWNER
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Name | CHUCK WELLS
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Credential |
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Telephone | 423-566-1967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 3585
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License Number State | TN
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