Provider Demographics
NPI:1356889257
Name:WEINTRAUB, MICHAEL (PHARM BS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WEINTRAUB
Suffix:
Gender:M
Credentials:PHARM BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10799 N 90TH ST
Mailing Address - Street 2:SUITE 200 - SECOND FLOOR
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6110
Mailing Address - Country:US
Mailing Address - Phone:480-614-0060
Mailing Address - Fax:480-614-0160
Practice Address - Street 1:10799 N 90TH STREET
Practice Address - Street 2:SUITE 200 - SECOND FLOOR
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6166
Practice Address - Country:US
Practice Address - Phone:480-614-0060
Practice Address - Fax:480-614-0160
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35778183500000X
NV07923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist