Provider Demographics
NPI:1285814137
Name:WEAVER, ASHLEY SUZANE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SUZANE
Last Name:WEAVER
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 1:895 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-2912
Mailing Address - Country:US
Mailing Address - Phone:660-831-5220
Mailing Address - Fax:660-530-4522
Practice Address - Street 1:895 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-2912
Practice Address - Country:US
Practice Address - Phone:660-831-5220
Practice Address - Fax:660-530-4522
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000165336183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist