Provider Demographics
NPI:1205962479
Name:WELLS, DEBRA LEA (DPH)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LEA
Last Name:WELLS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 E 80TH PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-8144
Mailing Address - Country:US
Mailing Address - Phone:918-481-8702
Mailing Address - Fax:918-493-6452
Practice Address - Street 1:8002 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-8945
Practice Address - Country:US
Practice Address - Phone:918-492-4242
Practice Address - Fax:918-493-6452
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist