MEDICARE: STACY WELDON

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	5302042736	MI

General Provider Information

NPI Number	:	1487173134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY WELDON

Provider Business Mailing Address
First Line	:	301 S COCHRAN AVE
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-1518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 S COCHRAN AVE
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-1518
Country	:	US
Telephone Number	:	517-543-4905
Fax Number	:

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

Provider Enumeration Date	:	09/13/2017
Last Update Date	:	09/13/2017

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Directions to “ STACY WELDON ” Practice Location

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