Organization
WELLS PHARMACY NETWORK LLC
Active
Organization
WELLS PHARMACY NETWORK LLC
Active
Other names
Wells Pharmacy Network LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CLINT MYERS (PHARMACIST IN CHARGE)
(731) 882-7000
Entity
Organization
Contact information
Practice address
450 US HIGHWAY 51 BYP N, DYERSBURG, TN 38024-3655
(731) 882-7000
(731) 882-7000
Mailing address
450 US HIGHWAY 51 BYP N, DYERSBURG, TN 38024-3655
(731) 882-7000
(731) 882-7000
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5058
TN
3336C0004X
Compounding Pharmacy
—
—
3336M0002X
Mail Order Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4445272
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/10/2012
Last updated
10/19/2012
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