Healthcare Provider Details

I. General information

NPI: 1639115322
Provider Name (Legal Business Name): ROBERT LEONARD WELCH PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 TURTLE PT
SALTILLO MS
38866-5771
US

IV. Provider business mailing address

102 TURTLE PT
SALTILLO MS
38866-5771
US

V. Phone/Fax

Practice location:
  • Phone: 662-213-5234
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE09585
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: