Healthcare Provider Details

I. General information

NPI: 1922371764
Provider Name (Legal Business Name): WELCH FAMILY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 S MADISON ST
TUPELO MS
38801-4905
US

IV. Provider business mailing address

848 S MADISON ST
TUPELO MS
38801-4905
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10617/1.1
License Number StateMS

VIII. Authorized Official

Name: ROBERT WELCH
Title or Position: OWNER
Credential:
Phone: 662-213-5234