Provider Demographics
NPI:1043372659
Name:WEATHERBY, WANDA K (PHARMD)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:K
Last Name:WEATHERBY
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 1:1060 GAFFNEY RD
Mailing Address - Street 2:BLDG 4076
Mailing Address - City:FT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7440
Mailing Address - Country:US
Mailing Address - Phone:907-361-5435
Mailing Address - Fax:907-361-4838
Practice Address - Street 1:1060 GAFFNEY RD
Practice Address - Street 2:BLDG 4076
Practice Address - City:FT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-5002
Practice Address - Country:US
Practice Address - Phone:907-361-5435
Practice Address - Fax:907-361-4838
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132821835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist