Provider Demographics
NPI:1760484190
Name:WEISS, DAVID L (R PH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:L
Last Name:WEISS
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 181ST ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9137
Mailing Address - Country:US
Mailing Address - Phone:317-896-3477
Mailing Address - Fax:317-896-3477
Practice Address - Street 1:103 S UNION ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9458
Practice Address - Country:US
Practice Address - Phone:317-896-9378
Practice Address - Fax:317-896-2731
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014639A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist