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General NPI Number Information
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NPI Number | 1508473398
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Entity Type | Individual
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Provider Name | BRYANNA LYNN WELLER
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Gender | Female
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Dates
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Enumeration Date | 09/26/2020
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Last Update Date | 09/26/2020
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Provider Practice Location Address
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Address Line | 430 SE 192ND AVE
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City | VANCOUVER
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State | WA
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Zip | 98683-9531
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Country | US
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Telephone | 360-256-6361
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Fax |
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Provider Business Mailing Address
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Address Line | 1228 58TH PL SW
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City | EVERETT
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State | WA
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Zip | 98203-5910
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Country | US
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Telephone | 425-760-4721
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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 | PH61061250
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License Number State | WA
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