Provider Demographics
NPI:1376303594
Name:WEAVER, JESSICA (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5384 HIGHWAY 20 S
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4403
Mailing Address - Country:US
Mailing Address - Phone:770-788-6566
Mailing Address - Fax:
Practice Address - Street 1:5384 HIGHWAY 20 S
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4403
Practice Address - Country:US
Practice Address - Phone:770-788-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist