Provider Demographics
NPI:1700116811
Name:WESTON, ROBERT ERNEST (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERNEST
Last Name:WESTON
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 1:475 W FINNIE FLATS RD
Mailing Address - Street 2:
Mailing Address - City:CAMP VERDE
Mailing Address - State:AZ
Mailing Address - Zip Code:86322-7398
Mailing Address - Country:US
Mailing Address - Phone:928-239-3187
Mailing Address - Fax:
Practice Address - Street 1:475 W FINNIE FLATS RD
Practice Address - Street 2:
Practice Address - City:CAMP VERDE
Practice Address - State:AZ
Practice Address - Zip Code:86322-7398
Practice Address - Country:US
Practice Address - Phone:928-239-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist