Organization
WELLSPRING PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE WISTHOFF (PHARMACIST IN CHARGE)
(615) 462-5093
Entity
Organization
Contact information
Practice address
599 SAM RIDLEY PKWY W STE 103, SMYRNA, TN 37167-5646
(615) 462-5093
(615) 462-5079
Mailing address
599 SAM RIDLEY PKWY W, SUITE 103, SMYRNA, TN 37167-5645
(615) 462-5093
(615) 462-5079
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0000005943
TN
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167331
PK
—
Enumeration date
01/13/2017
Last updated
04/05/2017
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