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General NPI Number Information
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NPI Number | 1194092213
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Entity Type | Individual
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Provider Name | ANDREW WELBURN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 03/24/2016
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Provider Practice Location Address
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Address Line | 7920 SHAVER RD
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City | PORTAGE
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State | MI
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Zip | 49024-5121
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Country | US
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Telephone | 269-324-9988
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Fax | 269-324-7921
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Provider Business Mailing Address
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Address Line | 8393 GRAPEVINE CIR
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City | MATTAWAN
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State | MI
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Zip | 49071-8432
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Country | US
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Telephone | 269-267-7987
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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 | 5302034203
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License Number State | MI
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