MEDICARE: MITCHELL WELTON PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S023996	AZ

General Provider Information

NPI Number	:	1134771785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL WELTON PHARMD

Provider Business Mailing Address
First Line	:	1430 E FORT LOWELL RD STE 120
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2366
Country	:	US
Telephone Number	:	520-580-5020
Fax Number	:	520-795-0850

Provider Business Practice Location Address
First Line	:	1430 E FORT LOWELL RD STE 120
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-2366
Country	:	US
Telephone Number	:	520-580-5020
Fax Number	:	520-795-0850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2019
Last Update Date	:	07/14/2019

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