Provider Demographics
NPI:1053490516
Name:WEINTRAUB, DIANE ELIZABETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:WEINTRAUB
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8504 NE 100TH STREET
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157
Mailing Address - Country:US
Mailing Address - Phone:816-415-8108
Mailing Address - Fax:816-468-6229
Practice Address - Street 1:4400 BROADWAY
Practice Address - Street 2:SUITE 106
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3498
Practice Address - Country:US
Practice Address - Phone:816-931-0100
Practice Address - Fax:816-931-3677
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO44746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist