Provider Demographics
NPI:1942537600
Name:WEAVER, MAROLYN REYNOLDS (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MAROLYN
Middle Name:REYNOLDS
Last Name:WEAVER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-5144
Mailing Address - Country:US
Mailing Address - Phone:325-695-1440
Mailing Address - Fax:325-795-1374
Practice Address - Street 1:3033 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-5144
Practice Address - Country:US
Practice Address - Phone:325-695-1440
Practice Address - Fax:325-795-1374
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist