Provider Demographics
NPI:1588128268
Name:WELLS-HARRIS, CALVIN
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:
Last Name:WELLS-HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 MICHAYWE DR
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8750
Mailing Address - Country:US
Mailing Address - Phone:989-858-6638
Mailing Address - Fax:
Practice Address - Street 1:55 MICHAYWE DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8750
Practice Address - Country:US
Practice Address - Phone:989-858-6638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-26
Last Update Date:2019-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302044597183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist