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1467635060 NPI number — LISA MARIE WELLER RPH

NPI Number: 1467635060
Health Care Provider/Practitioner: LISA MARIE WELLER RPH

Information about “1467635060” NPI (LISA MARIE WELLER RPH) exists in 1467635060 in HTML format HTML  |  1467635060 in plain Text format TXT  |  1467635060 in PDF (Portable Document Format) PDF  |  1467635060 in an XML format XML  formats.

NPI Number : 1467635060 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467635060",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WELLER",
    "FirstName": "LISA",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "RPH",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9241 SHELLEY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MARCY",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "13403-2623",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "315-206-4071",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1729 BURRSTONE RD",
    "SecondLinePracticeLocationAddress": "SUITE 201",
    "PracticeLocationAddressCityName": "NEW HARTFORD",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "13413-1001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "315-798-1724",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/06/2007",
    "LastUpdateDate": "08/18/2009",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "042804",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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