Provider Demographics
NPI:1013523372
Name:WELLER, BRENDA (RPH)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:WELLER
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 1:100 E POTOMAC ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:MD
Mailing Address - Zip Code:21795-1108
Mailing Address - Country:US
Mailing Address - Phone:301-223-4101
Mailing Address - Fax:
Practice Address - Street 1:100 E POTOMAC ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:MD
Practice Address - Zip Code:21795-1108
Practice Address - Country:US
Practice Address - Phone:301-223-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12796183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist