Provider Demographics
NPI:1659425932
Name:WEAVER, BRIDGETTE L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:BRIDGETTE
Middle Name:L
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-2107
Mailing Address - Country:US
Mailing Address - Phone:304-788-0453
Mailing Address - Fax:
Practice Address - Street 1:22 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:WV
Practice Address - Zip Code:26750-1036
Practice Address - Country:US
Practice Address - Phone:304-355-2700
Practice Address - Fax:304-355-8800
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005521183500000X
MD14084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist