Healthcare Provider Details

I. General information

NPI: 1710286588
Provider Name (Legal Business Name): MR. ALAN LOUIS WEISSMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2011
Last Update Date: 03/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 W MAIN ST
AVON CT
06001-4357
US

IV. Provider business mailing address

71 BART DR
COLLINSVILLE CT
06019-3045
US

V. Phone/Fax

Practice location:
  • Phone: 860-674-0027
  • Fax: 860-674-0442
Mailing address:
  • Phone: 860-693-9467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10448
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number027619-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: