Provider Demographics
NPI:1295065449
Name:WEAVER, RAINEY L (RPH)
Entity type:Individual
Prefix:MRS
First Name:RAINEY
Middle Name:L
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 1:1825 E WARNER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-3403
Mailing Address - Country:US
Mailing Address - Phone:480-820-9984
Mailing Address - Fax:480-820-6115
Practice Address - Street 1:1825 E WARNER RD STE 108
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-3403
Practice Address - Country:US
Practice Address - Phone:480-820-9984
Practice Address - Fax:480-820-6115
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS011036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist