MEDICARE: RICHARD LEE WELLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	5302414168	MI

General Provider Information

NPI Number	:	1023753829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD LEE WELLS

Provider Business Mailing Address
First Line	:	519 E BROOK DR
Second Line	:
City	:	NEWAYGO
State	:	MI
Zip	:	49337-8573
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 N LAFAYETTE ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1166
Country	:	US
Telephone Number	:	616-754-3625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/05/2022

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Directions to “ RICHARD LEE WELLS ” Practice Location

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