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General NPI Number Information
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NPI Number | 1821499666
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Entity Type | Individual
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Provider Name | ALISA WELBOURN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 04/05/2020
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Provider Practice Location Address
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Address Line | 15701 S 71ST CT DEPT OF
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City | ORLAND PARK
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State | IL
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Zip | 60462-6800
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Country | US
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Telephone | 708-342-9910
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Fax | 83-429-9657
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Provider Business Mailing Address
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Address Line | 15701 S 71ST CT
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City | ORLAND PARK
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State | IL
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Zip | 60462-6800
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Country | US
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Telephone | 708-342-9910
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Fax | 708-342-9965
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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 | 26025804A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051298262
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License Number State | IL
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