Provider Demographics
NPI:1013191063
Name:WELCH, RAMONA LOU (RPH)
Entity Type:Individual
Prefix:MS
First Name:RAMONA
Middle Name:LOU
Last Name:WELCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35631 N BANDOLIER DR
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-3170
Mailing Address - Country:US
Mailing Address - Phone:197-649-7191
Mailing Address - Fax:
Practice Address - Street 1:1845 E BROADWAY RD STE 120
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1634
Practice Address - Country:US
Practice Address - Phone:480-699-8044
Practice Address - Fax:806-218-0094
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0201871835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14499OtherPHARMACIST LICENSE