Provider Demographics
NPI:1386002269
Name:WEAVER, ROBERT BRYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRYAN
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 8TH AVE
Mailing Address - Street 2:SUITE #130
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2601
Mailing Address - Country:US
Mailing Address - Phone:817-335-5712
Mailing Address - Fax:866-326-9731
Practice Address - Street 1:800 8TH AVE
Practice Address - Street 2:SUITE #130
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2601
Practice Address - Country:US
Practice Address - Phone:817-335-5712
Practice Address - Fax:866-326-9731
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41637183500000X
OK15859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist