Provider Demographics
NPI:1104009695
Name:WEINER, ANDREA JO (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:JO
Last Name:WEINER
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 1:3371 JASON CT
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5429
Mailing Address - Country:US
Mailing Address - Phone:516-785-0718
Mailing Address - Fax:
Practice Address - Street 1:3371 JASON CT
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5429
Practice Address - Country:US
Practice Address - Phone:516-785-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist