Provider Demographics
NPI:1164703369
Name:WEIENBERG, LACY E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LACY
Middle Name:E
Last Name:WEIENBERG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1A TROLLEY SQ
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3334
Mailing Address - Country:US
Mailing Address - Phone:302-655-6397
Mailing Address - Fax:302-654-1284
Practice Address - Street 1:1A TROLLEY SQ
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-3334
Practice Address - Country:US
Practice Address - Phone:302-655-6397
Practice Address - Fax:302-654-1284
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003648183500000X
PARP442177183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist