Provider Demographics
NPI:1790463644
Name:WELCH, JASIHA LANDON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JASIHA
Middle Name:LANDON
Last Name:WELCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 H ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-1851
Mailing Address - Country:US
Mailing Address - Phone:704-340-1960
Mailing Address - Fax:
Practice Address - Street 1:1120 E GERMAN LN
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4555
Practice Address - Country:US
Practice Address - Phone:501-329-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD16651183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist