Provider Demographics
NPI:1750972386
Name:WEISSFISCH, YENNY LORENA
Entity type:Individual
Prefix:
First Name:YENNY
Middle Name:LORENA
Last Name:WEISSFISCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12680 W LAKE HOUSTON PKWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-6087
Mailing Address - Country:US
Mailing Address - Phone:281-436-1969
Mailing Address - Fax:281-436-0783
Practice Address - Street 1:12680 W LAKE HOUSTON PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-6087
Practice Address - Country:US
Practice Address - Phone:281-436-1969
Practice Address - Fax:281-436-0783
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120404183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician