Provider Demographics
NPI:1023024494
Name:WEAKS, SUSAN MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MARIE
Last Name:WEAKS
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 1:4360 CONTEST RD
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8846
Mailing Address - Country:US
Mailing Address - Phone:270-655-6151
Mailing Address - Fax:270-655-6301
Practice Address - Street 1:521 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4543
Practice Address - Country:US
Practice Address - Phone:270-442-6659
Practice Address - Fax:270-442-8982
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY012002183500000X
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist