Provider Demographics
NPI:1366035537
Name:WEAVER, KASIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KASIE
Middle Name:
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 1:511 RIVER HILL RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIA
Mailing Address - State:GA
Mailing Address - Zip Code:30531-5903
Mailing Address - Country:US
Mailing Address - Phone:706-768-2954
Mailing Address - Fax:
Practice Address - Street 1:410A W LOUISE ST
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-5808
Practice Address - Country:US
Practice Address - Phone:706-754-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist