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General NPI Number Information
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NPI Number | 1790034460
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Entity Type | Organization
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Legal Business Name | WELLS PHARMACY NETWORK LLC
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Dates
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Enumeration Date | 09/10/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 450 US HIGHWAY 51 BYP N
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City | DYERSBURG
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State | TN
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Zip | 38024-3655
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Country | US
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Telephone | 731-882-7000
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Fax | 731-882-7000
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Provider Business Mailing Address
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Address Line | 450 US HIGHWAY 51 BYP N
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City | DYERSBURG
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State | TN
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Zip | 38024-3655
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Country | US
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Telephone | 731-882-7000
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Fax | 731-882-7000
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | CLINT MYERS
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Credential |
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Telephone | 731-882-7000
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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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Taxonomy #2
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5058
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License Number State | TN
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