Provider Demographics
NPI:1811134018
Name:WEISS, JACQUELINE (RPH)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:WEISS
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 1:1020 HIGHWAY 15 S
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3184
Mailing Address - Country:US
Mailing Address - Phone:320-587-8070
Mailing Address - Fax:320-234-9725
Practice Address - Street 1:1020 HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3184
Practice Address - Country:US
Practice Address - Phone:320-587-8070
Practice Address - Fax:320-234-9725
Is Sole Proprietor?:No
Enumeration Date:2009-01-10
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN115046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist