MEDICARE: MS. PORTIA A WELLS 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	PCT.9370	CT

General Provider Information

NPI Number	:	1700109428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PORTIA A WELLS RPH

Provider Business Mailing Address
First Line	:	11 GENESEE ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06513-2714
Country	:	US
Telephone Number	:	203-687-9291
Fax Number	:	203-468-9795

Provider Business Practice Location Address
First Line	:	157 MAIN ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2525
Country	:	US
Telephone Number	:	203-468-9732
Fax Number	:	203-468-9795

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	03/09/2010

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