Provider Demographics
NPI:1730294521
Name:WELLER, CHARLOTTE LEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLOTTE
Middle Name:LEN
Last Name:WELLER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16937 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-8057
Mailing Address - Country:US
Mailing Address - Phone:903-871-0214
Mailing Address - Fax:903-593-4681
Practice Address - Street 1:2020 ROSELAND BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4248
Practice Address - Country:US
Practice Address - Phone:903-597-1358
Practice Address - Fax:903-593-4681
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist