Healthcare Provider Details

I. General information

NPI: 1790463644
Provider Name (Legal Business Name): JASIHA LANDON WELCH PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 E GERMAN LN
CONWAY AR
72032-4555
US

IV. Provider business mailing address

5101 H ST APT 6
LITTLE ROCK AR
72205-1851
US

V. Phone/Fax

Practice location:
  • Phone: 501-329-3733
  • Fax:
Mailing address:
  • Phone: 704-340-1960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD16651
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: