Provider Demographics
NPI:1639130958
Name:WEINER, PHILLIP PAUL (PHARMD, CO)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:PAUL
Last Name:WEINER
Suffix:
Gender:M
Credentials:PHARMD, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 OLD COURT RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3915
Mailing Address - Country:US
Mailing Address - Phone:410-653-1433
Mailing Address - Fax:410-653-0319
Practice Address - Street 1:3635 OLD COURT RD
Practice Address - Street 2:SUITE C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3915
Practice Address - Country:US
Practice Address - Phone:410-653-1433
Practice Address - Fax:410-653-0319
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06194183500000X
MDC19386222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No183500000XPharmacy Service ProvidersPharmacist