Provider Demographics
NPI:1710281712
Name:WEIS, KIERAN PATRICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:KIERAN
Middle Name:PATRICK
Last Name:WEIS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5935 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15853-5721
Mailing Address - Country:US
Mailing Address - Phone:814-787-4400
Mailing Address - Fax:
Practice Address - Street 1:18496 BENNETTS VALLEY HWY
Practice Address - Street 2:
Practice Address - City:WEEDVILLE
Practice Address - State:PA
Practice Address - Zip Code:15868
Practice Address - Country:US
Practice Address - Phone:814-787-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP036186L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist