Provider Demographics
NPI:1235240615
Name:WELLER, KEVIN P (RPH)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:P
Last Name:WELLER
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:PO BOX 45
Mailing Address - Street 2:
Mailing Address - City:WOOLRICH
Mailing Address - State:PA
Mailing Address - Zip Code:17779-0045
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 BELLEFONTE AVE
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-1904
Practice Address - Country:US
Practice Address - Phone:570-748-8260
Practice Address - Fax:570-893-6548
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041856L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist