Provider Demographics
NPI:1962844340
Name:WEAVER, MICHAEL JAMES (PHARMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAMES
Last Name:WEAVER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 FOUNDERS PKWY
Mailing Address - Street 2:TARGET STORE 1326
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7838
Mailing Address - Country:US
Mailing Address - Phone:303-663-4322
Mailing Address - Fax:
Practice Address - Street 1:5010 FOUNDERS PKWY
Practice Address - Street 2:TARGET STORE 1326
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7838
Practice Address - Country:US
Practice Address - Phone:303-663-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0019936183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist