Provider Demographics
NPI:1396360731
Name:WELCH, KATELIN
Entity Type:Individual
Prefix:
First Name:KATELIN
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2344 195TH ST
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:IA
Mailing Address - Zip Code:50830-8195
Mailing Address - Country:US
Mailing Address - Phone:641-202-6111
Mailing Address - Fax:
Practice Address - Street 1:806 LAUREL ST
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:IA
Practice Address - Zip Code:50801-3554
Practice Address - Country:US
Practice Address - Phone:641-782-6951
Practice Address - Fax:641-782-6960
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist