Provider Demographics
NPI:1699224253
Name:WEAVER, KATHERINE TENNEY (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:TENNEY
Last Name:WEAVER
Suffix:
Gender:F
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:PO BOX 796
Mailing Address - Street 2:307 EAST OAK ST
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785
Mailing Address - Country:US
Mailing Address - Phone:620-757-8018
Mailing Address - Fax:417-276-4194
Practice Address - Street 1:19 PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785-7617
Practice Address - Country:US
Practice Address - Phone:417-276-3128
Practice Address - Fax:417-276-4194
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016021936183500000X
KS1-100197183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist