Provider Demographics
NPI:1346264496
Name:WEAVER, JANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
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 1:312 KENMORE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-7462
Mailing Address - Country:US
Mailing Address - Phone:850-471-7648
Mailing Address - Fax:850-471-7633
Practice Address - Street 1:312 KENMORE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-7462
Practice Address - Country:US
Practice Address - Phone:850-471-7648
Practice Address - Fax:850-471-7633
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist