Provider Demographics
NPI:1245513647
Name:LEVENTRY, WELDON D (RPH)
Entity type:Individual
Prefix:
First Name:WELDON
Middle Name:D
Last Name:LEVENTRY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MARROWS RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-3701
Mailing Address - Country:US
Mailing Address - Phone:302-369-2510
Mailing Address - Fax:302-369-1758
Practice Address - Street 1:19 MARROWS RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3701
Practice Address - Country:US
Practice Address - Phone:302-369-2510
Practice Address - Fax:302-369-1758
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0001678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist