Provider Demographics
NPI:1285300996
Name:WELLS BROS. PHARMACY SERVICES, LLC
Entity type:Organization
Organization Name:WELLS BROS. PHARMACY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MYLO
Authorized Official - Middle Name:E
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-208-6889
Mailing Address - Street 1:206 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1425
Mailing Address - Country:US
Mailing Address - Phone:641-208-6889
Mailing Address - Fax:
Practice Address - Street 1:206 S 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:IA
Practice Address - Zip Code:52626-9235
Practice Address - Country:US
Practice Address - Phone:319-878-4232
Practice Address - Fax:319-878-4210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WELLS BROS. PHARMACY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-22
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy