Provider Demographics
NPI:1336821552
Name:WELSH, JACQUELINE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:WELSH
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 1:1326 LAKE FLOYD CIR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:WV
Mailing Address - Zip Code:26426-7367
Mailing Address - Country:US
Mailing Address - Phone:304-685-9480
Mailing Address - Fax:614-384-5347
Practice Address - Street 1:102 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-4580
Practice Address - Country:US
Practice Address - Phone:304-292-3080
Practice Address - Fax:800-230-3083
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist