Provider Demographics
NPI:1780085076
Name:WELLS, EILEEN LOULIE (PHARMD)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:LOULIE
Last Name:WELLS
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 1:123 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2002
Mailing Address - Country:US
Mailing Address - Phone:410-295-3061
Mailing Address - Fax:410-295-3067
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2002
Practice Address - Country:US
Practice Address - Phone:410-295-3061
Practice Address - Fax:410-295-3067
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist