Provider Demographics
NPI:1407179120
Name:WEINERT, JODI ANN (RPH)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ANN
Last Name:WEINERT
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 1:82 JOSEPH DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-6222
Mailing Address - Country:US
Mailing Address - Phone:716-871-1490
Mailing Address - Fax:716-871-1496
Practice Address - Street 1:2739 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2701
Practice Address - Country:US
Practice Address - Phone:716-871-1490
Practice Address - Fax:716-692-0616
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist