Provider Demographics
NPI:1619223575
Name:WEAVER, CHARLES ROY (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ROY
Last Name:WEAVER
Suffix:
Gender:M
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:PO BOX 9512
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-9512
Mailing Address - Country:US
Mailing Address - Phone:940-692-3819
Mailing Address - Fax:940-691-5455
Practice Address - Street 1:4122 CALL FIELD RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2517
Practice Address - Country:US
Practice Address - Phone:940-692-1234
Practice Address - Fax:940-691-5455
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist