Provider Demographics
NPI:1417788787
Name:WELLS-KINGSBURY, JAMIE MICHELE (PHARMD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:MICHELE
Last Name:WELLS-KINGSBURY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 TYLER PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1537
Mailing Address - Country:US
Mailing Address - Phone:502-773-3933
Mailing Address - Fax:
Practice Address - Street 1:1803 TYLER PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1537
Practice Address - Country:US
Practice Address - Phone:502-773-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program