Provider Demographics
NPI:1942500012
Name:WEAVER, SHAUNA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:WEAVER
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:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:PEBBLE BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93953-1212
Mailing Address - Country:US
Mailing Address - Phone:831-915-0407
Mailing Address - Fax:
Practice Address - Street 1:104 MID VALLEY CTR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8500
Practice Address - Country:US
Practice Address - Phone:831-624-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist