Healthcare Provider Details

I. General information

NPI: 1508787532
Provider Name (Legal Business Name): CORINNE WELTY PHARM.D., MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 VALLEY CREEK DR
FARMINGTON MO
63640-1969
US

IV. Provider business mailing address

403 ROPER LOOP
FARMINGTON MO
63640-7986
US

V. Phone/Fax

Practice location:
  • Phone: 573-747-1191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2026035344
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: