MEDICARE: NICOLE MARIE WELCH

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	5585	SD

General Provider Information

NPI Number	:	1255622882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE WELCH

Provider Business Mailing Address
First Line	:	2605 W 12TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-3816
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2605 W 12TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-3816
Country	:	US
Telephone Number	:	605-357-9359
Fax Number	:

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

Provider Enumeration Date	:	04/30/2011
Last Update Date	:	04/30/2011

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Directions to “ NICOLE MARIE WELCH ” Practice Location

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