Healthcare Provider Details

I. General information

NPI: 1518590900
Provider Name (Legal Business Name): ANDREA LYNN WELDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 JOHNSON AVE NW
CEDAR RAPIDS IA
52405-4207
US

IV. Provider business mailing address

5627 MUIRFIELD DR SW UNIT 5
CEDAR RAPIDS IA
52404-7385
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-7419
  • Fax: 319-396-5916
Mailing address:
  • Phone: 319-930-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23614
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: