Provider Demographics
NPI:1124428388
Name:WEBER, STEPHANIE (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WEBER
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 1:2411 WILLIAMS DR STE 3
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3261
Mailing Address - Country:US
Mailing Address - Phone:512-863-5579
Mailing Address - Fax:
Practice Address - Street 1:2411 WILLIAMS DR STE 3
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3261
Practice Address - Country:US
Practice Address - Phone:512-863-5579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist