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General NPI Number Information
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NPI Number | 1063923712
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Entity Type | Individual
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Provider Name | COURTNEY WELLER PHARMD
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Gender | Female
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Dates
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Enumeration Date | 10/21/2017
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 18741 E RED FOX TRL
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City | OWASSO
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State | OK
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Zip | 74055-8341
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Country | US
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Telephone | 612-777-4536
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Fax |
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Provider Business Mailing Address
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Address Line | 519 W EL PASO ST
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City | BROKEN ARROW
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State | OK
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Zip | 74012-4044
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Country | US
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Telephone | 918-340-4656
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 16121
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License Number State | OK
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