Healthcare Provider Details

I. General information

NPI: 1780700997
Provider Name (Legal Business Name): BRAD WELAGE PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 TRI COUNTY PKWY
CINCINNATI OH
45246-3217
US

IV. Provider business mailing address

6803 MOSSY ROCK CT
MAINEVILLE OH
45039-7531
US

V. Phone/Fax

Practice location:
  • Phone: 513-782-3366
  • Fax: 513-782-8760
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03122415
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03122415
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number014633
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: