Healthcare Provider Details

I. General information

NPI: 1033493739
Provider Name (Legal Business Name): BRUCE G WEIS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 EL CAMINO REAL
ATASCADERO CA
93422-5211
US

IV. Provider business mailing address

8005 EL CAMINO REAL
ATASCADERO CA
93422-5211
US

V. Phone/Fax

Practice location:
  • Phone: 805-462-9272
  • Fax: 805-462-8406
Mailing address:
  • Phone: 805-462-9272
  • Fax: 805-462-8406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH30652
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number06783
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: