Provider Demographics
NPI:1982371910
Name:WEISMAN, MICHELLE NICOLE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:NICOLE
Last Name:WEISMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1208 ROCKVIEW RD
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1885
Mailing Address - Country:US
Mailing Address - Phone:219-895-6467
Mailing Address - Fax:
Practice Address - Street 1:5758 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1426
Practice Address - Country:US
Practice Address - Phone:773-834-2285
Practice Address - Fax:773-926-0700
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029960A183500000X
IL051302332183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist