1962818781 NPI number — MRS. ANDREA LOUISE WELCH PHARMD

Table of content: MRS. ANDREA LOUISE WELCH PHARMD (NPI 1962818781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962818781 NPI number — MRS. ANDREA LOUISE WELCH PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELCH
Provider First Name:
ANDREA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GALLMAN
Provider Other First Name:
ANDREA
Provider Other Middle Name:
LOUISE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962818781
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
969 POST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUTLAND
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05701-0989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-558-0559
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 RUTLAND SHOPPING PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTLAND
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-773-1600
Provider Business Practice Location Address Fax Number:
802-773-0269
Provider Enumeration Date:
07/02/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  24105 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 033.0105811 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)