Provider Demographics
NPI:1821422734
Name:WEAKS, ALEXIS C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:C
Last Name:WEAKS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:C
Other - Last Name:KOUNTOURIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3600 O'NEILL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-4963
Mailing Address - Country:US
Mailing Address - Phone:517-788-5961
Mailing Address - Fax:
Practice Address - Street 1:3600 O'NEILL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-4963
Practice Address - Country:US
Practice Address - Phone:517-788-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23676183500000X
MI5302043254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist