MEDICARE: ROBERT WELLS III RPH

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	051-032945	IL

General Provider Information

NPI Number	:	1457648297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT WELLS III RPH

Provider Business Mailing Address
First Line	:	16925 UNIVERSITY CT
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-3146
Country	:	US
Telephone Number	:	708-331-9696
Fax Number	:	708-333-1224

Provider Business Practice Location Address
First Line	:	1717 E WEST RD # T-0846
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5414
Country	:	US
Telephone Number	:	708-730-3101
Fax Number	:	708-730-3101

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

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	06/06/2017

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