Provider Demographics
NPI:1265755342
Name:WEAVER, RICHARD MADISON (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MADISON
Last Name:WEAVER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CHESTNUT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILLS RIVER
Mailing Address - State:NC
Mailing Address - Zip Code:28759-8002
Mailing Address - Country:US
Mailing Address - Phone:828-545-9203
Mailing Address - Fax:
Practice Address - Street 1:601 SPARTANBURG HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5762
Practice Address - Country:US
Practice Address - Phone:828-692-0761
Practice Address - Fax:828-692-6714
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012569183500000X
NC20908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist