1043606452 NPI number — WELLS DRUGS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043606452 NPI number — WELLS DRUGS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLS DRUGS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIGGS DRUG JACKSBORO
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043606452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSBORO
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37757-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-566-1967
Provider Business Mailing Address Fax Number:
423-566-1797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2636 JACKSBORO PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37757-4848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-566-1967
Provider Business Practice Location Address Fax Number:
423-566-1797
Provider Enumeration Date:
04/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WELLS
Authorized Official First Name:
CHUCK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
423-566-1967

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  3585 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2151662 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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