Provider Demographics
NPI:1073944526
Name:WEINTRAUB, BERNARD ABRAHAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:ABRAHAM
Last Name:WEINTRAUB
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 1:200 SPARTAN DR
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-3428
Mailing Address - Country:US
Mailing Address - Phone:407-920-8144
Mailing Address - Fax:
Practice Address - Street 1:200 SPARTAN DR
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-3428
Practice Address - Country:US
Practice Address - Phone:407-920-8144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0018615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist