Provider Demographics
NPI:1285715235
Name:WEISS, ORVILLE WAYNE (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:ORVILLE
Middle Name:WAYNE
Last Name:WEISS
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 BIG OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044
Mailing Address - Country:US
Mailing Address - Phone:972-202-1140
Mailing Address - Fax:972-235-6968
Practice Address - Street 1:57 ARAPAHO VILLAGE
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-235-7133
Practice Address - Fax:972-235-6968
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXVP1410884Medicaid
TXVP1410884Medicaid