Provider Demographics
NPI:1134771785
Name:WELTON, MITCHELL (PHARMD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:WELTON
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 1:1430 E FORT LOWELL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2366
Mailing Address - Country:US
Mailing Address - Phone:520-580-5020
Mailing Address - Fax:520-795-0850
Practice Address - Street 1:1430 E FORT LOWELL RD STE 120
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2366
Practice Address - Country:US
Practice Address - Phone:520-580-5020
Practice Address - Fax:520-795-0850
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023996183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist