Provider Demographics
NPI:1942581178
Name:WELVEART, BETH ELLEN (RPH)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ELLEN
Last Name:WELVEART
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 1:1301 AVENUE OF THE CITIES
Mailing Address - Street 2:
Mailing Address - City:EAST MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61244-4114
Mailing Address - Country:US
Mailing Address - Phone:309-755-0325
Mailing Address - Fax:
Practice Address - Street 1:1301 AVENUE OF THE CITIES
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244
Practice Address - Country:US
Practice Address - Phone:309-755-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18727183500000X
IL051.040091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist