Provider Demographics
NPI:1134839012
Name:WELDON, JESSICA ANN (RPH)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:WELDON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2311 W SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 BROOKS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6649
Practice Address - Country:US
Practice Address - Phone:406-728-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6448183500000X
MTPHA-PHA-LIC-91893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist