Provider Demographics
NPI:1689715427
Name:WEAVER PHARMACY INC
Entity Type:Organization
Organization Name:WEAVER PHARMACY INC
Other - Org Name:WEAVERS CORNER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARM
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALHADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:239-995-2700
Mailing Address - Street 1:1866 N TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-3366
Mailing Address - Country:US
Mailing Address - Phone:239-995-2700
Mailing Address - Fax:239-995-2707
Practice Address - Street 1:1866 N TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3366
Practice Address - Country:US
Practice Address - Phone:239-995-2700
Practice Address - Fax:239-995-2707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 3336S0011X
FLPH200213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1004162OtherNCPDP PROVIDER IDENTIFICATION NUMBER
FL026680900Medicaid
FL026680900Medicaid