Provider Demographics
NPI:1831101617
Name:WEBER, PAULYNN MARY (RPH)
Entity Type:Individual
Prefix:
First Name:PAULYNN
Middle Name:MARY
Last Name:WEBER
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 1:5800 W WAHNER AVE
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53223-2958
Mailing Address - Country:US
Mailing Address - Phone:414-357-7095
Mailing Address - Fax:
Practice Address - Street 1:4081 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:WI
Practice Address - Zip Code:53211-2361
Practice Address - Country:US
Practice Address - Phone:414-961-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9897-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist