Provider Demographics
NPI:1770842791
Name:WEAVER, MELONEE DENIESE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MELONEE
Middle Name:DENIESE
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 1:24314 SYLVAN GLEN RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4536
Mailing Address - Country:US
Mailing Address - Phone:909-860-3720
Mailing Address - Fax:
Practice Address - Street 1:24314 SYLVAN GLEN RD UNIT D
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4536
Practice Address - Country:US
Practice Address - Phone:909-860-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44426183500000X
NV10992183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist