Provider Demographics
NPI:1073796348
Name:WEISS, DOROTHY MAE
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MAE
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15009 44TH DR NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8955
Mailing Address - Country:US
Mailing Address - Phone:360-657-4730
Mailing Address - Fax:
Practice Address - Street 1:13619 MUKILTEO SPEEDWAY
Practice Address - Street 2:C
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-1626
Practice Address - Country:US
Practice Address - Phone:425-742-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAVA00066492183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician