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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