Provider Demographics
NPI:1114216181
Name:WEAVER, KATHRYN LEA (RPH)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEA
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 GENERAL GEORGE PATTON RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-2461
Mailing Address - Country:US
Mailing Address - Phone:615-662-6899
Mailing Address - Fax:
Practice Address - Street 1:2131 ABBOTT MARTIN RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2699
Practice Address - Country:US
Practice Address - Phone:615-297-4431
Practice Address - Fax:615-269-7170
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000028078183500000X
TX021420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist