Provider Demographics
NPI:1821545328
Name:WEAVER, DANIELLE (RPH, PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RPH, PHARMD, MBA
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 321
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520-0321
Mailing Address - Country:US
Mailing Address - Phone:406-378-5588
Mailing Address - Fax:
Practice Address - Street 1:158 JOHANNES AVE
Practice Address - Street 2:
Practice Address - City:BIG SANDY
Practice Address - State:MT
Practice Address - Zip Code:59520-0321
Practice Address - Country:US
Practice Address - Phone:406-378-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MT39229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy