Provider Demographics
NPI:1588001507
Name:WEATHERLY, ADAM R (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:R
Last Name:WEATHERLY
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 1:110 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4017
Mailing Address - Country:US
Mailing Address - Phone:731-642-3531
Mailing Address - Fax:731-642-3575
Practice Address - Street 1:110 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4017
Practice Address - Country:US
Practice Address - Phone:731-642-3531
Practice Address - Fax:731-642-3575
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist