Provider Demographics
NPI:1285266684
Name:WEISS, BRIANNE MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRIANNE
Middle Name:MARIE
Last Name:WEISS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DEER PARK AVE APT 3A
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2896
Mailing Address - Country:US
Mailing Address - Phone:631-828-9936
Mailing Address - Fax:
Practice Address - Street 1:196 N BELLE MEAD RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3477
Practice Address - Country:US
Practice Address - Phone:631-444-0784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist