Healthcare Provider Details

I. General information

NPI: 1750051272
Provider Name (Legal Business Name): JEFFERY WELCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S CHESTNUT ST
REED CITY MI
49677-1206
US

IV. Provider business mailing address

1 WHITE BIRCH DR
REED CITY MI
49677-9187
US

V. Phone/Fax

Practice location:
  • Phone: 231-832-5542
  • Fax:
Mailing address:
  • Phone: 231-468-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: