Provider Demographics
NPI:1356649214
Name:WEAVER, ROBERT ALLEN (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:WEAVER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 INDEPENDENCE ST
Mailing Address - Street 2:PO BOX 314
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473
Mailing Address - Country:US
Mailing Address - Phone:724-736-4422
Mailing Address - Fax:724-736-0715
Practice Address - Street 1:301 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473
Practice Address - Country:US
Practice Address - Phone:724-736-4422
Practice Address - Fax:724-736-0715
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP026719L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist