Provider Demographics
NPI:1003566571
Name:WEAVER, DANIELLE RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RENEE
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 1:550 GENE FRIEND WAY APT 614
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2289
Mailing Address - Country:US
Mailing Address - Phone:717-332-3863
Mailing Address - Fax:
Practice Address - Street 1:550 GENE FRIEND WAY APT 614
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2289
Practice Address - Country:US
Practice Address - Phone:717-332-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA456457183500000X, 405300000X
CA85593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA85593OtherPHARMACIST LICENSE NUMBER