Provider Demographics
NPI:1710322284
Name:WELCH, MICHELLE SWENSON (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SWENSON
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 1:351 W CARBURY ST
Mailing Address - Street 2:
Mailing Address - City:TEKOA
Mailing Address - State:WA
Mailing Address - Zip Code:99033-9789
Mailing Address - Country:US
Mailing Address - Phone:509-648-3430
Mailing Address - Fax:509-648-3217
Practice Address - Street 1:18 E FRONT ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:WA
Practice Address - Zip Code:99171-8775
Practice Address - Country:US
Practice Address - Phone:509-648-3430
Practice Address - Fax:509-648-3217
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA16990183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist