Healthcare Provider Details

I. General information

NPI: 1427201102
Provider Name (Legal Business Name): LLOYD DION WELGEMOED R.PH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NW LOGAN RD
LINCOLN CITY OR
97367-5056
US

IV. Provider business mailing address

PO BOX 935
NEOTSU OR
97364-0935
US

V. Phone/Fax

Practice location:
  • Phone: 541-994-2500
  • Fax: 866-994-8438
Mailing address:
  • Phone: 541-921-1642
  • Fax: 541-994-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH-0011154
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: