Provider Demographics
NPI:1831968494
Name:WELCH, BROGAN MCKAY (PHARMD)
Entity type:Individual
Prefix:
First Name:BROGAN
Middle Name:MCKAY
Last Name:WELCH
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 1:1879 E FORBES CT
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-5602
Mailing Address - Country:US
Mailing Address - Phone:360-281-2763
Mailing Address - Fax:
Practice Address - Street 1:2615 NE 112TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-4283
Practice Address - Country:US
Practice Address - Phone:360-449-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH61480128183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist