Provider Demographics
NPI:1053179838
Name:WELLS, CAITLIN MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARIE
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 1:20698 NE COMET CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3403
Mailing Address - Country:US
Mailing Address - Phone:154-154-3801
Mailing Address - Fax:
Practice Address - Street 1:20698 NE COMET CT
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3403
Practice Address - Country:US
Practice Address - Phone:541-543-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0013124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist