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General NPI Number Information
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NPI Number | 1710690656
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Entity Type | Organization
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Legal Business Name | WELLSPRING PHARMACY HEALTH INC.
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 1987 W 4TH ST STE 200
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City | ONTARIO
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State | OH
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Zip | 44906-1708
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Country | US
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Telephone | 419-756-2559
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Fax |
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Provider Business Mailing Address
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Address Line | 1987 W 4TH ST STE 200
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City | ONTARIO
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State | OH
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Zip | 44906-1708
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Country | US
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Telephone | 419-756-2559
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHANIE NICHOLE LANE
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Credential | PHARM D
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Telephone | 419-961-2593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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