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General NPI Number Information
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NPI Number | 1972523629
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Entity Type | Organization
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Legal Business Name | BLUEWELLS FAMILY PHARMACY INC
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 3675 COAL HERITAGE RD
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City | BLUEFIELD
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State | WV
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Zip | 24701-9511
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Country | US
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Telephone | 304-589-7788
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Fax | 304-589-7759
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Provider Business Mailing Address
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Address Line | PO BOX 118
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City | BLUEFIELD
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State | WV
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Zip | 24701-0118
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Country | US
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Telephone | 304-589-7788
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Fax | 304-589-7759
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Authorized Official
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Title or Position | PRESIDENT, OWNER, PIC, AO
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Name | HAROLD WELLS
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Credential | RPH
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Telephone | 304-589-7788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | MP0552305
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License Number State | WV
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