Provider Demographics
NPI:1497849566
Name:WELLER, SAMUEL C III (BS)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:C
Last Name:WELLER
Suffix:III
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972
Mailing Address - Country:US
Mailing Address - Phone:239-368-0990
Mailing Address - Fax:
Practice Address - Street 1:57 HOMESTEAD RD N
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936
Practice Address - Country:US
Practice Address - Phone:239-369-0141
Practice Address - Fax:239-368-0843
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37001183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist