Healthcare Provider Details

I. General information

NPI: 1902906720
Provider Name (Legal Business Name): KAREN LYNNE WEISE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE ROOM L602A
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

521 PARNASSUS AVENUE ROOM C-0152
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1325
  • Fax:
Mailing address:
  • Phone: 415-353-8828
  • Fax: 415-353-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number56930
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03226414
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: