Provider Demographics
NPI:1811128408
Name:WEISSMAN, ALAN NORMAN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:NORMAN
Last Name:WEISSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 CENTER LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-3123
Mailing Address - Country:US
Mailing Address - Phone:207-227-4545
Mailing Address - Fax:
Practice Address - Street 1:112 BENNETT DR
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-2022
Practice Address - Country:US
Practice Address - Phone:207-498-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3719183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist