Provider Demographics
NPI:1194848366
Name:WELLS, CHARLES ALAN (RPH)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALAN
Last Name:WELLS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757
Mailing Address - Country:US
Mailing Address - Phone:423-871-1967
Mailing Address - Fax:
Practice Address - Street 1:2636 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766
Practice Address - Country:US
Practice Address - Phone:423-566-1967
Practice Address - Fax:423-566-1797
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist