Provider Demographics
NPI:1497902381
Name:WOODY WEAVER PHARMACY, INC.
Entity Type:Organization
Organization Name:WOODY WEAVER PHARMACY, INC.
Other - Org Name:WEAVER HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COTY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-597-4363
Mailing Address - Street 1:PO BOX 130008
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0008
Mailing Address - Country:US
Mailing Address - Phone:903-597-4363
Mailing Address - Fax:903-526-7617
Practice Address - Street 1:506 E RUSK ST
Practice Address - Street 2:101
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-4992
Practice Address - Country:US
Practice Address - Phone:903-597-4363
Practice Address - Fax:903-526-7617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODY WEAVER PHARMACY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0092940332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies