Provider Demographics
NPI:1164989190
Name:WETLI, MORGAN CHANTEL (RPH)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:CHANTEL
Last Name:WETLI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:CHANTEL
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4901 STATE ROAD 26 E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4901 STATE ROAD 26 E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4611
Practice Address - Country:US
Practice Address - Phone:765-449-9210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26027811A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist