Provider Demographics
NPI:1134253347
Name:WELTER-KNOKE, TERI L (PHARMD)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:L
Last Name:WELTER-KNOKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 HWY 61
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-9448
Mailing Address - Country:US
Mailing Address - Phone:608-723-7679
Mailing Address - Fax:608-723-6202
Practice Address - Street 1:1625 HWY 61
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-9448
Practice Address - Country:US
Practice Address - Phone:608-723-7679
Practice Address - Fax:608-723-6202
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14556-040183500000X
IL051.287823183500000X
IA19458183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist