Provider Demographics
NPI:1003191537
Name:WEITH, JOSHUA RICHARD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:RICHARD
Last Name:WEITH
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 1:1117 W 17TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2302
Mailing Address - Country:US
Mailing Address - Phone:815-347-3084
Mailing Address - Fax:
Practice Address - Street 1:1117 W 17TH ST
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2302
Practice Address - Country:US
Practice Address - Phone:815-347-3084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-16
Last Update Date:2011-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist