Provider Demographics
NPI:1376884684
Name:WEIMER, LINUS J
Entity Type:Individual
Prefix:MR
First Name:LINUS
Middle Name:J
Last Name:WEIMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N ANDOVER RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9508
Mailing Address - Country:US
Mailing Address - Phone:316-218-0819
Mailing Address - Fax:316-218-0320
Practice Address - Street 1:440 N ANDOVER RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-9508
Practice Address - Country:US
Practice Address - Phone:316-218-0819
Practice Address - Fax:316-218-0320
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS09555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist