Provider Demographics
NPI:1891819892
Name:WEAVER, ALLEN BRUCE (RPH)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:BRUCE
Last Name:WEAVER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15753 BALMORAL CT
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-2594
Mailing Address - Country:US
Mailing Address - Phone:440-238-1568
Mailing Address - Fax:
Practice Address - Street 1:3402 CLARK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1136
Practice Address - Country:US
Practice Address - Phone:216-961-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-12438183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist