Provider Demographics
NPI:1659979532
Name:WELCH, TERESA (RPH)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:WELCH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12195 SINGLETREE LN
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-4214
Mailing Address - Country:US
Mailing Address - Phone:952-829-9030
Mailing Address - Fax:
Practice Address - Street 1:12195 SINGLETREE LN
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-4214
Practice Address - Country:US
Practice Address - Phone:952-829-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist