Provider Demographics
NPI:1407183643
Name:WEATHERS, RENE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:LYNN
Last Name:WEATHERS
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 1:325 LEGACY LAKES WAY
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-4042
Mailing Address - Country:US
Mailing Address - Phone:910-944-1502
Mailing Address - Fax:
Practice Address - Street 1:1706 N SANDHILLS BLVD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315-2004
Practice Address - Country:US
Practice Address - Phone:910-944-1502
Practice Address - Fax:910-944-1641
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028770183500000X
NC12669183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist