Provider Demographics
NPI:1821372707
Name:WEAVER, KATHY L (RPH)
Entity Type:Individual
Prefix:MS
First Name:KATHY
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 1:4510 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4510 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4940
Practice Address - Country:US
Practice Address - Phone:727-844-7029
Practice Address - Fax:727-845-1065
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0029969183500000X
IN26018696A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist