Provider Demographics
NPI:1225160880
Name:WELLNER, SIMON (RPH)
Entity Type:Individual
Prefix:
First Name:SIMON
Middle Name:
Last Name:WELLNER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 RIVERWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77345-1115
Mailing Address - Country:US
Mailing Address - Phone:713-741-0343
Mailing Address - Fax:713-741-0139
Practice Address - Street 1:9494 KIRBY DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2521
Practice Address - Country:US
Practice Address - Phone:713-741-0343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist