Provider Demographics
NPI:1831581214
Name:WEISS, DUSTIN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:
Last Name:WEISS
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 HUNT RD
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45236-1100
Mailing Address - Country:US
Mailing Address - Phone:513-792-1501
Mailing Address - Fax:513-792-1502
Practice Address - Street 1:4100 HUNT RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45236-1100
Practice Address - Country:US
Practice Address - Phone:513-792-1501
Practice Address - Fax:513-792-1502
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-232829183500000X
KY016467183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist