Provider Demographics
NPI:1104909639
Name:WELLDYNE, INC.
Entity type:Organization
Organization Name:WELLDYNE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-645-2613
Mailing Address - Street 1:7472 S TUCSON WAY
Mailing Address - Street 2:SUITE 100-B
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4452
Mailing Address - Country:US
Mailing Address - Phone:800-641-8475
Mailing Address - Fax:800-530-8589
Practice Address - Street 1:7472 S TUCSON WAY
Practice Address - Street 2:SUITE 100-B
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4452
Practice Address - Country:US
Practice Address - Phone:800-641-8475
Practice Address - Fax:800-530-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3700000593336S0011X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0613302OtherNCPDP
SC7C0059Medicaid
CO03001245Medicaid