Provider Demographics
NPI:1093886319
Name:T.P. WEAVER & SONS INC.
Entity Type:Organization
Organization Name:T.P. WEAVER & SONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:254-893-6496
Mailing Address - Street 1:124 N TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:DE LEON
Mailing Address - State:TX
Mailing Address - Zip Code:76444-1857
Mailing Address - Country:US
Mailing Address - Phone:254-893-6496
Mailing Address - Fax:254-893-5341
Practice Address - Street 1:124 N TEXAS ST
Practice Address - Street 2:
Practice Address - City:DE LEON
Practice Address - State:TX
Practice Address - Zip Code:76444-1857
Practice Address - Country:US
Practice Address - Phone:254-893-6496
Practice Address - Fax:254-893-5341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00528333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4518239OtherNABP
TX140706Medicaid
TX4518239OtherNABP