Provider Demographics
NPI:1356939318
Name:HAUSE, ALEX WELLAND (CPHT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:WELLAND
Last Name:HAUSE
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 HAMPDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-2015
Mailing Address - Country:US
Mailing Address - Phone:573-433-1373
Mailing Address - Fax:
Practice Address - Street 1:1112 W WYOMISSING BLVD
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-2259
Practice Address - Country:US
Practice Address - Phone:610-775-3409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC30001251183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC30001251OtherPHARMACY TECHNICIAN CERTIFICATION BOARD