Provider Demographics
NPI:1629297247
Name:WESTON, GRADY SCOTT (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:SCOTT
Last Name:WESTON
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 CRUSADER BEND
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3035
Mailing Address - Country:US
Mailing Address - Phone:210-878-5225
Mailing Address - Fax:
Practice Address - Street 1:6102 FM 3009
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-3205
Practice Address - Country:US
Practice Address - Phone:210-651-9079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44795183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist