Provider Demographics
NPI:1629675400
Name:WEAVER, SHERMAN JAY (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHERMAN
Middle Name:JAY
Last Name:WEAVER
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 1:2665 DUNHILL DR
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-1214
Mailing Address - Country:US
Mailing Address - Phone:770-375-1889
Mailing Address - Fax:
Practice Address - Street 1:2665 DUNHILL DR
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1214
Practice Address - Country:US
Practice Address - Phone:770-375-1889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist