Provider Demographics
NPI:1881223089
Name:WEBER, MARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:WEBER
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:RR 1 BOX 245
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:OH
Mailing Address - Zip Code:43107-9104
Mailing Address - Country:US
Mailing Address - Phone:740-438-6907
Mailing Address - Fax:
Practice Address - Street 1:55 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2302
Practice Address - Country:US
Practice Address - Phone:740-592-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03132287183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist