Healthcare Provider Details

I. General information

NPI: 1871805655
Provider Name (Legal Business Name): NICOLE ANN WELLER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2010
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W BROAD ST
QUAKERTOWN PA
18951-1250
US

IV. Provider business mailing address

345 W BROAD ST
QUAKERTOWN PA
18951-1250
US

V. Phone/Fax

Practice location:
  • Phone: 215-536-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPI002025
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP443848
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: