MEDICARE: JUDITH L WEISS RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist		IL

General Provider Information

NPI Number	:	1548272859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH L WEISS RPH

Provider Business Mailing Address
First Line	:	409 CRESTWOOD DR
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-2324
Country	:	US
Telephone Number	:	618-344-5169
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 W MAIN ST
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-3016
Country	:	US
Telephone Number	:	618-345-2880
Fax Number	:	618-345-0899

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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Directions to “ JUDITH L WEISS RPH” Practice Location

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