Provider Demographics
NPI:1508461682
Name:WELTER, EMILY JANE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JANE
Last Name:WELTER
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 1:885 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1310
Mailing Address - Country:US
Mailing Address - Phone:518-459-4550
Mailing Address - Fax:
Practice Address - Street 1:35 TRUMPETER PL
Practice Address - Street 2:
Practice Address - City:SLINGERLANDS
Practice Address - State:NY
Practice Address - Zip Code:12159-9281
Practice Address - Country:US
Practice Address - Phone:518-641-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065886183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist