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General NPI Number Information
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NPI Number | 1447353511
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Entity Type | Organization
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Legal Business Name | LESLIE J WELLS
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 01/06/2016
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Provider Practice Location Address
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Address Line | 70 MAIN ST
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City | FRENCHBURG
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State | KY
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Zip | 40322-8318
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Country | US
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Telephone | 606-768-2161
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Fax | 606-768-2877
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Provider Business Mailing Address
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Address Line | PO BOX 109
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City | FRENCHBURG
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State | KY
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Zip | 40322-0109
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Country | US
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Telephone | 606-768-2161
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Fax | 606-768-2877
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Authorized Official
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Title or Position | OWNER
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Name | LESLIE WELLS
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Credential | RPH
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Telephone | 606-768-2161
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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 | P06137
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License Number State | KY
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