Provider Demographics
NPI:1306113337
Name:HESSON WELLING, STACY (RPH)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HESSON WELLING
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:HESSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6374 OLD MAHOGANY CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-7818
Mailing Address - Country:US
Mailing Address - Phone:239-596-8939
Mailing Address - Fax:
Practice Address - Street 1:6275 NAPLES BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2030
Practice Address - Country:US
Practice Address - Phone:239-596-6410
Practice Address - Fax:239-596-6427
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 30695183500000X
TX36236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist